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Войти в исследования HIV medicine · 2026
Perianal lesions in men who have sex with men living with HIV: Risk of precancer and cancer.
СтатьяНазвание и аннотация: Перевод в очереди
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Rastegar Shima, Gaisa Michael M, Xu Xinyang, Winters John, Rabinowitz Grace, Verma Hannah, Sigel Keith, Liu Yuxin
Аннотация
OBJECTIVES: Men who have sex with men living with HIV (MSMLWH) are at highest risk for human papillomavirus (HPV)-associated anal cancer, which may originate from the anal canal, verge or perianal skin. Perianal lesions are frequently overlooked during examination, and their (pre)malignant burden in this population remains poorly characterized.
METHODS: A total of 308 MSMLWH who underwent high-resolution anoscopy (HRA)-guided perianal biopsy between 2018 and 2024 were analysed. Demographics, clinical HIV parameters, smoking history, HPV vaccination status, anal cytology, high-risk HPV test results and histologic diagnoses were collected. Risk factors for perianal (pre)cancer were assessed using chi-square and rank-sum tests.
RESULTS: Median age was 52 years (range 27-72). Prevalence of abnormal anal cytology (atypical squamous cells of undetermined significance [ASCUS] or worse), high-risk HPV and HPV16 was 85%, 77% and 30%, respectively. Intra-anal high-grade squamous intraepithelial lesion (HSIL) was detected in 48%. Histologic diagnoses of perianal lesions included negative (n = 12, 4%), low-grade squamous intraepithelial lesions (LSIL) (n = 236, 77%), HSIL (n = 55, 18%), basal cell carcinoma (n = 1, <1%) and superficially invasive squamous cell carcinoma (SISCCA, n = 4, 1%). Perianal HSIL without intra-anal HSIL occurred in 8% of participants, with 82% of HSILs found in verrucous lesions. Perianal HSIL/SISCCA was strongly associated with high-risk HPV, HPV16 and intra-anal HSIL (p = 0.002). HPV16 was the strongest predictor (odds ratio [OR] 5.6; 95% CI 2.9-10.8).
CONCLUSIONS: Perianal lesions in MSMLWH have significant (pre)malignant potential, particularly in the context of HPV16 infection. Thorough examination and low threshold for biopsy are essential for effective cancer prevention.
METHODS: A total of 308 MSMLWH who underwent high-resolution anoscopy (HRA)-guided perianal biopsy between 2018 and 2024 were analysed. Demographics, clinical HIV parameters, smoking history, HPV vaccination status, anal cytology, high-risk HPV test results and histologic diagnoses were collected. Risk factors for perianal (pre)cancer were assessed using chi-square and rank-sum tests.
RESULTS: Median age was 52 years (range 27-72). Prevalence of abnormal anal cytology (atypical squamous cells of undetermined significance [ASCUS] or worse), high-risk HPV and HPV16 was 85%, 77% and 30%, respectively. Intra-anal high-grade squamous intraepithelial lesion (HSIL) was detected in 48%. Histologic diagnoses of perianal lesions included negative (n = 12, 4%), low-grade squamous intraepithelial lesions (LSIL) (n = 236, 77%), HSIL (n = 55, 18%), basal cell carcinoma (n = 1, <1%) and superficially invasive squamous cell carcinoma (SISCCA, n = 4, 1%). Perianal HSIL without intra-anal HSIL occurred in 8% of participants, with 82% of HSILs found in verrucous lesions. Perianal HSIL/SISCCA was strongly associated with high-risk HPV, HPV16 and intra-anal HSIL (p = 0.002). HPV16 was the strongest predictor (odds ratio [OR] 5.6; 95% CI 2.9-10.8).
CONCLUSIONS: Perianal lesions in MSMLWH have significant (pre)malignant potential, particularly in the context of HPV16 infection. Thorough examination and low threshold for biopsy are essential for effective cancer prevention.