870 
Factors Associated with Prevalent Squamous Intraepithelial Lesions in a Large Cohort of HIV-infected US Adults: Preliminary Results from the SUN Study
Lois Conley*1, T Bush1, J Palefsky2, T Darragh2, E Kojic3, S Cu-Uvin3, H Martin4, T Overton5, E Unger1, and J Brooks1
1CDC, Atlanta, GA, US; 2Univ of California, San Francisco, US; 3Miriam Hosp, Providence, RI, US; 4Park-Nicollet Inst, Minneapolis, MN, US; and 5Washington Univ Sch of Med, St Louis, MO, US
Background: Although the
incidence of anal cancer and its precursor squamous
intraepithelial lesions (SIL) are higher in HIV-infected men who have sex with
men (MSM) compared to the general population, prevalence of SIL and risk
factors for its development in other HIV-infected individuals (eg, heterosexual men, women) have not been extensively
investigated.
Methods: The SUN study
is an ongoing prospective cohort study of HIV-infected patients receiving care
at clinics in Denver, Minneapolis,
Providence, and St Louis. At baseline, all patients completed
a behavioral risk questionnaire and providers collected, among other specimens,
separate Dacron anorectal swabs for cytopathologic
examination, as well as human papillomavirus (HPV)
detection and genotyping using the Roche Linear Assay.
Results: Among the
first 538 participants (410 men and 128 women) enrolled in the study, median
age was 41 years, 80% were receiving HAART, 40% had CD4 cells counts ≥500
cells/mm3 (median 451 cells/mm3) and 58% had undetectable
viral loads. Cytologic results were negative for 289
(54%), atypical squamous cells of undetermined
significance (ASCUS) 82 (15%), low-grade SIL 130 (24%), and high-grade SIL 37 (7%). Univariate analysis indicated that the
following were associated with SIL (p
<0.05): male gender; MSM; use of alcohol,
poppers, and drugs other than marijuana; white race; sexual intercourse in the
last 6 months; multiple sex partners; HPV infection; and nadir, as well as current,
CD4 cell count. In multivariate analysis, the number of HPV types (OR 1.2,
95%CI 1.1 to 1.3), nadir CD4 cell count <50 cells/mm3 (OR 2.8,
95%CI 1.6 to 5.0), current CD4 count <500 cells/mm3 (OR 1.9,
95%CI 1.2 to 3.0), MSM (OR 2.1, 95%CI 1.2 to 3.9), and ever receptive anal
intercourse (OR 2.1, 95%CI 1.1 to 4.2) remained associated.
Conclusions: In this large cohort of generally healthy, HIV-infected
men and women, prevalence of SIL was high (31%). Anal cytology screening should
be considered in HIV-infected persons, particularly those who participate in
anal intercourse, have multiple HPV types, a nadir CD4 cell count <50 cells/mm3, or a current CD4 count <500 cells/mm3. Research on appropriate follow-up (eg, indications for and frequency of high-resolution
anoscopy) is needed.
|
