Prevalence and risk factors for anal cytologic abnormalities and human papillomavirus infection in a rural population of HIV-infected males.

PURPOSE: This study was designed to determine the prevalence and risk factors for anal squamous intraepithelial lesions and human papillomavirus infection in a rural population of HIV-infected males.

METHODS

A cross-sectional study was performed. Risk factors were collected. Anal Papanicolaou smear and human papillomavirus screening for oncogenic types were performed.

RESULTS

Of 211 eligible male patients, 149 (70.6 percent) participated. HIV transmission risk was predominantly males who have sex with males (82 percent). The mean duration of HIV infection was 9.9 years. Ninety (60 percent) males had abnormal anal cytology, including atypical cells of unknown significance 40 (26 percent), low-grade squamous intraepithelial lesions 28 (19 percent), and high-grade squamous intraepithelial lesions 22 (15 percent). Human papillomavirus was detected in 61 percent. Binary logistic regression adjusted risks for abnormal anal cytology included: males who have sex with males (P<0.001), human papillomavirus infection (P<0.001), history of anogenital warts (P=0.014), and the mean lowest CD4 count (abnormal cytology, 158 (standard deviation, 135), negative cytology, 208 (standard deviation, 180; P=0.017)). Twenty-two patients with high-grade squamous intraepithelial lesions underwent colorectal surgical examination and anoscopy. Two (10 percent) were found to have invasive squamous-cell carcinoma and three (15 percent) others had mass lesions with high-grade squamous intraepithelial lesions.

CONCLUSIONS

Anal squamous intraepithelial lesions and oncogenic human papillomavirus are highly prevalent in males infected with HIV and living in a rural setting.