Palefsky J, Holly EA, Ralston ML, Jay NJ, Berry JM, Darragh TM; International Conference on AIDS.
Int Conf AIDS. 1998; 12: 323 (abstract no. 22302).
University of California, San Francisco 94143, USA.
OBJECTIVES: The incidence of anal cancer among men who have sex with men (MSM) exceeds that of cervical cancer in women, and may be even higher among HIV-positive gay MSM than HIV-negative MSM. Cervical cancer is preceded by high-grade squamous intraepithelial lesions (HSIL) and anal HSIL may similarly be the precursor to anal cancer. In this study, we characterized the four-year incidence of and risk factors for HSIL in HIV-positive and HIV-negative MSM. METHODS: We conducted a prospective cohort study of 259 HIV-positive and 217 HIV-negative MSM at the University of California San Francisco. A questionnaire was administered detailing lifestyle habits, medical history and sexual practices. Anal swabs for cytology and HPV detection were obtained, followed by biopsies of visible lesions. Polymerase chain reaction (PCR) was used to test for HPV. Blood was obtained for HIV tests and to measure CD4 levels. RESULTS: HIV-positive MSM were more likely to develop HSIL than HIV-negative MSM (RR 3.7, 95% CI 2.6-5.7). Life-table estimates of the 4-year incidence of HSIL were 49% (95% CI 41-56) among HIV-positive MSM and 17% (95% CI 12-23) among HIV-negative MSM. Among HIV-positive men, those with lower baseline CD4 counts (p = .007) were more likely to develop HSIL, as were men with persistent infection with one or more HPV types detected by PCR (p = .0001). However, 33% of HIV-positive MSM with baseline CD4 counts of at least 500/mm3 developed HSIL. Risk of incident HSIL increased among HIV-positive men when compared to HIV-negative men as CD4 counts decreased (p for trend < .0005). CONCLUSIONS: HIV infection, lower CD4 levels and persistent anal HPV infection were associated with higher rates of incident HSIL among MSM. However, high rates of incident HSIL were found at all CD4 levels among HIV-positive MSM as well as among HIV-negative MSM. These men should be considered at risk for developing invasive anal cancer.
Publication Types:
Keywords:
- Anal Canal
- Anus Diseases
- Anus Neoplasms
- CD4 Lymphocyte Count
- California
- Carcinoma in Situ
- Cohort Studies
- Female
- HIV Infections
- HIV Seropositivity
- Homosexuality
- Homosexuality, Male
- Humans
- Incidence
- Longitudinal Studies
- Male
- Neoplasms, Squamous Cell
- Papillomaviridae
- Prospective Studies
- Risk Factors
- San Francisco
- Uterine Cervical Neoplasms
- epidemiology
Other ID:
UI: 102228341
From Meeting Abstracts