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1 November 2004

Volume 190, Number 9
The Journal of Infectious Diseases 2004;190:1685–1691
© 2004 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2004/19009-0022$15.00
DOI: 10.1086/424599
MAJOR ARTICLE

Anal Intraepithelial Neoplasia in Heterosexual and Homosexual HIV‐Positive Men with Access to Antiretroviral Therapy

T. J. Wilkin,1

S. Palmer,2

K. F. Brudney,3

M. A. Chiasson,3,5 and

T. C. Wright4

1Division of International Medicine and Infectious Diseases, Weill Medical College of Cornell University, 2New York–Presbyterian Hospital, 3Division of Infectious Diseases and 4Department of Pathology, Columbia University College of Physicians and Surgeons, and 5Medical and Health Research Association of New York City, New York, New York

Background.Studies of human immunodeficiency virus (HIV)–positive men have demonstrated high rates of anal intraepithelial neoplasia (AIN), a precursor to anal carcinoma, mostly in white homosexual men and men not receiving effective antiretroviral therapy (ART).

Methods.Ninety‐two participants—53% Latino, 36% African American, and 40% without a history of receptive anal intercourse (RAI)—were evaluated with a behavioral questionnaire, liquid‐based anal cytological testing, Hybrid Capture 2 human papillomavirus (HPV) DNA assay and polymerase chain reaction, and anal colposcopy with biopsy of lesions.

Results.High‐risk HPV DNA was identified in 61%, and this was associated with a history of RAI (78% vs. 33%; ); 47% had abnormal cytological results, and 40% had AIN on biopsy. In multivariate analysis, both were associated with a history of RAI (odds ratio [OR], 10 [ ] and OR, 3.6 [ ], respectively) and lower nadir CD4+ cell counts ( and ). Current ART use was protective (OR, 0.09; and OR, 0.18; ).

Conclusions.Although anal infections with high‐risk HPV and AIN in HIV‐positive men are associated with a history of RAI, both conditions are commonly identified in HIV‐positive men without this history. Both lower nadir CD4+ cell counts and lack of current ART were associated with AIN but not with the detection of anal HPV.

Received 20 February 2004; accepted 13 May 2004; electronically published 1 October 2004.

Reprints or correspondence: Dr. Timothy J. Wilkin, Div. of International Medicine and Infectious Diseases, Weill Medical College of Cornell University, 119 W. 24th St., Ground Floor, New York, NY 10011 ().

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  • Presented in part: 10th Conference on Retroviruses and Opportunistic Infections, Boston, 10–14 February 2003 (abstract 819).

    Financial support: National Cancer Institute, National Institutes of Health (National Research Service Award); Columbia‐Rockefeller Center for AIDS Research (Research Development Grant).

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