Prevalence and risk factors associated with high-grade anal squamous intraepithelial lesions (HSIL)-AIN2 and HSIL-AIN3 in homosexual men Academic Article uri icon

abstract

  • Anal intraepithelial neoplasia grade 2 (AIN2) and AIN grade 3 (AIN3) are commonly grouped together as high grade squamous intraepithelial lesions (HSIL). We assessed risk factors for HSIL-AIN2 and HSIL-AIN3 in a cohort of homosexual men.At the baseline visit in the Study for the Prevention of Anal Cancer (SPANC), all men completed a questionnaire and underwent anal swabbing for cytology and HPV genotyping, followed by high resolution anoscopy.Composite-HSIL prevalence was 47% and 32% among 220 HIV-positive and 396 HIV-negative men, respectively. HSIL-AIN3 (37.7% versus 24.7%; p<0.001), but not HSIL-AIN2 (9.5% versus 7.6%; p=0.395) was more common in HIV-positive men. Recent receptive anal partners (p-trend=0.045), and increasing number of high-risk (HR)-HPV types (p-trend<0.001) were associated with HSIL-AIN2. Lifetime receptive partners (p-trend<0.001), HIV status (OR 1.74; 95% CI: 1.05-2.87) and HPV16 (OR 3.00; 95% CI: 1.56-5.75) were associated with HSIL-AIN3. HPV16 was the most common HR-HPV type detected in men with HSIL-AIN3, both HIV-negative (61.1%) and HIV-positive (54.9%). HPV16 was less commonly detected in men with HSIL-AIN2.Grouping HSIL-AIN2 and HSIL-AIN3 as HSIL may mask considerable heterogeneity in anal cancer risk. Given the strong link between HPV16 and anal cancer, men with HSIL-AIN3 and HPV16 are likely to be at greatest risk of cancer.

authors

  • Machalek, DA
  • Jin, F
  • Poynten, IM
  • Hillman, RJ
  • Templeton, DJ
  • Law, C
  • Roberts, JM
  • Tabrizi, SN
  • Garland, SM
  • Farnsworth, A
  • Fairley, CK
  • Grulich, AE
  • Acraman, B
  • Adams, M
  • Carr, A
  • Carroll, S
  • Cooper, D
  • Cornall, A
  • Crampton, L
  • Ekman, D
  • Feeney, L
  • Fraissard, E
  • Howard, K
  • Law, M
  • McCaffery, K
  • McDonald, R
  • McGrath, P
  • Mellor, R
  • Norris, R
  • O'Dwyer, M
  • Pendlebury, S
  • Petoumenos, K
  • Phillips, S
  • Prestage, G
  • Richards, A
  • Schema, L
  • Seeds, D
  • Segelov, E
  • Thurloe, J
  • Tong, W
  • Varma, R

publication date

  • 2016