Genotypes and Risk Factors for Anal Cytological Abnormalities in People Living With HIV and High-Risk Human Papillomavirus: The GAIA 2 Study Cytological Abnormalities in People Living With HIV and High-Risk Human Papillomavirus.

BACKGROUND

Human papillomavirus (HPV) infection is a major risk factor for cervical, anal, and oropharyngeal cancers, particularly in people living with HIV (PWH), who face higher HPV prevalence, especially in men who have sex with men (MSM). Limited data on HPV in Mexican PWH highlight the need for targeted screening.

OBJECTIVE

To assess the prevalence of anal cytological abnormalities in PWH and their association with high-risk HPV genotypes.

METHODS

A cross-sectional study (2023-2025) at Hospital de Infectología 'La Raza', Mexico City, included 137 PWH with confirmed high-risk HPV. Anal cytology and PCR based HPV genotyping for 28 genotypes were conducted. Multivariate logistic regression adjusted for confounders, including vaccination status.

RESULTS

Multiple high-risk HPV genotypes (> 3) were linked to abnormal cytology (OR 3.094, 95% CI 1.297-7.383, p = 0.009) and ASC-US (OR 3.060, 95% CI 1.177-7.954, p = 0.018). HPV 16+59 increased ASC-US risk (OR 5.450, 95% CI 1.259-23.600, p = 0.032). Vaccination reduced risks for abnormal cytology (OR 0.331, 95% CI 0.116-0.948, p = 0.039) and ASC-US (OR 0.209, 95% CI 0.053-0.823, p = 0.025).

CONCLUSION

High-risk HPV genotypes 16 and 59 and multiple HPV infections are risk factors for anal cytological abnormalities in PWH. Vaccination is protective, supporting enhanced screening and vaccination strategies to reduce HPV-related cancer risks.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: R-2025-3502-052.