Background: Previous studies of HIV⁺ men have demonstrated a high rate of anal SIL—a precursor to anal carcinoma, but they included predominantly white men who have sex with men and men not on effective Antiretroviral Therapy (ART). We examined the prevalence of anal Squamous Intraepithelial Lesions (SIL) and high-risk HPV in a group of HIV⁺ men including men of color, men with and without a history of receptive anal intercourse (RAI), and those on and off effective ART.

Methods: Cross-sectional study in ID clinic serving mainly Latino and African Americans. Participants were evaluated with a sexual questionnaire, Digene Hybrid Capture II HPV DNA assay for high-risk types of HPV, liquid-based cytology, and anal colposcopy with biopsy of visible lesions. Predictors of anal HPV, abnormal cytology, and anal SIL on biopsy were determined by chi square test, and logistic regression.

Results: Ninety-two (92) men were screened for anal HPV and anal SIL; 53% Latino, 36% African-American; 40% denied RAI ever, 82% were on ART, and 61% had HIV RNA < 400 copies/ml. The nadir CD4 count of those on ART (63 cells/mm³) was lower than those not on ART (290 cells/mm³), p < 0.001. Overall 47% had abnormal cytology: 18% atypical squamous cells of uncertain significance, 24% low grade SIL and 6% high grade SIL. Forty percent (40%) had abnormal histology: 31% low grade SIL, 9% high grade SIL.

 

Univariate predictors of HPV and anal SIL

		HPV		Abnormal cytology		Abnormal histology
		prevalence	p-value	prevalence	p-value	prevalence	p-value
RAI	yes	78%	0.008	65%	< 0.001	52%	0.007
	no	33%		18%		23%
ART	yes	65%	0.8	41%	0.025	37%	0.15
	no	60%		73%		56%
Age	£ 40	78%	0.01	65%	0.015	61%	0.003
	> 40	51%		37%		29%
Nadir CD4*		—	0.14	—	0.87	—	0.1

 

Multivariate predictors of HPV and anal SIL (Odds Ratio [95% CI])^†

	HPV	Abnormal Cytology	Abnormal histology
History of RAI	7.1 [2.6–20], p < 0.001	10 [3.0–36], p < 0.001	3.6 [1.2–11], p = 0.02
Current ART use	0.47 [0.11–2.0], p = 0.3	0.09 [0.02–0.51], p = 0.006‡	0.18 [.04–0.75], p = 0.02‡
Age £ 40	2.4 [0.8–7.0], p = 0.4	2.1 [0.72–6.2], p = 0.18	3.0 [1.1–8.3], p = 0.04
Nadir CD4*	0.68 [0.44–1.05], p = 0.08	0.625 [0.40–1.01], p = 0.06	0.56 [0.36–0.88], p = 0.01‡

*log transformation        

^†OR < 1 indicates protective effect

^‡Remains significant after controlling for high-risk HPV

 

Conclusions: Although anal high-risk HPV infections and SIL in HIV⁺ men are associated with a history of RAI, both conditions are commonly identified in HIV⁺ men who deny RAI. Using multivariate analysis both nadir CD4 and no current ART use are associated with anal SIL but not with detection of anal HPV.