Wednesday, June 17, 2009

Anal squamous intraepithelial lesions among HIV-positive and HIV-negative men who have sex with men in Thailand

Li AH, Phanuphak N, Sahasrabuddhe VV, Chaithongwongwatthana S, Vermund SH, Jenkins CA, Shepherd BE, Teeratakulpisarn N, van der Lugt J, Avihingsanon A, Ruxrungtham K, Shikuma C, Phanuphak P, Ananworanich J.

Vanderbilt University School of Medicine, TN, United States.


OBJECTIVES: To evaluate the prevalence and risk factors of anal squamous intraepithelial lesions (ASIL), the putative anal cancer precursor, in Asian HIV-positive and HIV-negative men who have sex with men (MSM).

METHODS: Men who underwent anal Pap smear reported clinical, sociodemographic, and behavioral information collected through questionnaire and interview between January 2007 and April 2008. Chi-square test and logistic regression were used to evaluate ASIL prevalence and risk factors among HIV-positive and HIV-negative MSM.

RESULTS: Of the 174 MSM (mean age 32.1 years), 118 (67.8%) were HIV-positive MSM. Overall, 27% had abnormal anal cytology: 13.2% had atypical squamous cells of undetermined significance (ASC-US), 11.5% had low-grade squamous intraepithelial lesion (LSIL), and 2.3% had high-grade squamous intraepithelial lesion (HSIL). Prevalence of ASIL was higher among HIV-positive than HIV-negative MSM (33.9% vs 12.5%, p=0.003). Among HIV-positive MSM, 16.1% had ASC-US, 14.4% had LSIL, and 3.4% had HSIL. These were 7.1%, 5.4%, and 0% in HIV-negative MSM, respectively. Anal condyloma was detected in 22% of HIV-positive and 16.1% (9/56) of HIV-negative MSM (p=0.5). In HIV-positive MSM, anal condyloma (OR 3.42, 95% CI 1.29 to 9.04, P=0.01) was a significant risk factor for ASIL. Highly active antiretroviral therapy (HAART) use and CD4+ T-cell count were not associated with ASIL.

CONCLUSIONS: One-third of HIV-positive and 12.5% of HIV-negative MSM had ASIL. Thus as greater numbers of HIV-positive MSM live longer due to increasing access to HAART worldwide, effective strategies to screen and manage anal precancerous lesions are needed.

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