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Background:  HIV-infected patients (pt) are at increased risk of developing ano-genital cancer. Condylomas are presumed to be precursor lesions for cancer. However, there are few data on the prevalence and risk factors for perianal and/or anal canal condyloma in the general HIV-infected population.

Methods:  Screening for anal condyloma was systematically proposed to 516 consecutive out-pt and followed in a university hospital in Paris. Perianal and systematic endoanal examinations with an anoscopy were realised. For each pt, HIV risk factors, sexual behaviors, previous history of genital condyloma and/or sexually transmitted diseases, CD4 cell count, CD4 nadir, and HIV-RNA were collected.

Results:  The 473 (92%) of examined pt consisted of 200 homosexual men, 123 heterosexual men, 150 women of whom 27 (18%) had a history of anoreceptive intercourse; 27% of pt were Centers for Disease Control and Prevention (CDC) stage C, 76% were receiving highly active antiretroviral (HAART), HIV-RNA was < 50 copies/mL in 60%, mean (± SD), and CD4 cell count and nadir were 484 (± 274)/mm³ and 220 (± 186)/mm³, retrospectively. Overall, 108 (23%) pt had histologically confirmed anal condyloma (36%, 15%, and 11% of the respective populations), including 51 (47%) pt with only endoanal localisation. Histologic examination revealed cervical intraepithelial neoplasia of grade I in 59 pt, grade II in 10 pt, grade III in 2 pt, and an invasive endoanal cancer in 1. Among homosexual men, condyloma were independently associated with the mean number of incidents of sexual intercourse per month (odds ratio [OR] = 1.03; confidence interval (CI) 95% (1.01 to 1.06), history of gonococcia or syphilis (OR = 0.54 [0.29 to0.99]), and history of previous anal condyloma (OR = 2.05 (1.07 to 3.92). Among heterosexual men, independent risk factors were a history of previous penis condyloma (OR = 26.8 [2.3 to 309.6]), and unprotected sexual intercourses (OR = 7.5 [2.1 to 26.3]). Among women, independent risk factors were CD4 cell count below 200/mm³, (OR = 8.9 [1.5 to 51.6]), receptive anal intercourses (OR 6.7 [1.7 to 25.8]) and history of previous anal condyloma (OR = 25.4 [3.4 to 188.2]).

Conclusion:  In the HAART era, systematic screening revealed a high rate of anal condyloma, not only in homosexual men but also in heterosexual men and women, with sexual behavior, history of condyloma and level of immunodepression identified as risk factors. Anal examination should be proposed systematically to at-risk populations.

Keywords: condyloma; risk factors; papillomavirus