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Prevalence of high-grade anal intraepithelial neoplasia (AIN) in anal lesions in HIV+ men who have sex with men (MSM) from a Venezuelan private medical center
S.M. Dickson-Gonzalez1, M. Uribe2, R. Alfonso3, M. Correnti3, M.E. Cavazza4, A. Rodriguez-Morales5
1Pathology Laboratory, Hospital de Clinicas de Caracas and Pathology Division, Luis Razetti Medical School, Central University of Venezuela, Caracas, Venezuela, 2Pathology Laboratory, Hospital de Clinicas de Caracas, Caracas, Venezuela, 3Oncology and Hematology Institute, Ministry of Health, Caracas, Venezuela, 4Biomedicine Institute, Central University of Venezuela, Caracas, Venezuela, 5Experimental Institute JWT, Los Andes University, Trujillo, Venezuela
Background: Anal intraepithelial neoplasia (AIN) is frequent in HIV-1-infected men-who-have-sex-with-men (MSM). High-grade AIN is considered the precursor of invasive anal squamous cell cancer. Anal condylomata, high-grade AIN, and anal squamous cell cancer are more common in MSM, particularly those with HIV. This study investigates the prevalence of histologically and molecularly confirmed high-grade AIN within anal lesions of MSM.
Methods: We studied 188 MSM evaluated at Hospital de Clinicas, one of main private Venezuelan medical centers. Coloproctological exam was performed and anal samples were collected for cytological, histological analyses, HPV-DNA-PCR and hibridization detection methods. Anal biopsy was performed with abnormal coloproctological exam. Cytology results were reported using two main categories: low-grade (LG-AIN) and high-grade (HG-AIN) anal intraepithelial neoplasia. Anal squamous cells of unknown significance (ASCUS) were reported. CD4+ T-cell counting and HIV-1-RNA viral level were evaluated. Low-risk HPV (6 and 11) and high-risk HPV (16/18/31/33/35) probes were used for HPV DNA amplification. Variables were analyzed with SPSS.
Results: Main patient age was 40.5±1.5 y-old, main CD4 counts 354.7±28.8 cells/mm3, geometric mean viral load 3.21±0.16 log HIV-RNA copies. From the total, 41.6% presented HG-AIN at cytology, 41.6% were normal, 0.5% LG-AIN(p<0.05). HPV DNA presence was detected in 56.3% of patients, in 75% of patients with SIL (p<0.05). HPV types 6 and 16 were the most commonly detected (6.3% each)(p>0.05), 13.7% classified as high-risk HPV, 15.8% low-risk, 5.8% mixed, 20% negative. Anal condylomata were found in 1.6% of patients, 2.6% presented ASCUS.
Conclusions: High-risk and low-risk HPV were detected. There was no relationship between specific HPV types identified and variables tested. Anal HPV was nearly universal in men infected with HIV and often caused by multiple types. High-grade AIN contained a HPV types greater burden. These data demonstrate high prevalence of HPV in HIV-infected MSM and suggest the need to develop HPV screening protocols for males.