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Article << Previous     |     Next >>   Contents Vol 9(6)

Prevalence and predictors of high-grade anal intraepithelial neoplasia in a community-based sample of homosexual men

Richard J. Hillman A F, Marina T. van Leeuwen B, Claire M. Vajdic C, Leo McHugh A, Garrett P. Prestage B, Leon P. Botes A, Iryna Zablotska B, Gabriele Medley D, Sepehr N. Tabrizi E, Andrew E. Grulich B and Fengyi Jin A

A Sexually Transmitted Infections Research Centre, University of Sydney, Marion Villa, Westmead, NSW 2145, Australia.
B Kirby Institute, University of New South Wales, Darlinghurst, NSW 2010, Australia.
C Prince of Wales Clinical School and Lowy Cancer Research Centre, Faculty of Medicine, Building C25, Faculty of Medicine, Kensington Campus, University of New South Wales, NSW 2052, Australia.
D Melbourne Pathology, Private Bag 5, Collingwood, Vic. 3066, Australia.
E Department of Microbiology and Infectious Diseases, Bio 21 Institute, The Royal Women’s Hospital, Parkville, Vic. 3052, Australia.
F Corresponding author. Email: richard.hillman@sydney.edu.au

Sexual Health 9(6) 574-579 http://dx.doi.org/10.1071/SH11139
Submitted: 7 March 2011  Accepted: 20 January 2012   Published: 11 May 2012


 
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Abstract

Background: We report the prevalence and predictors for high-grade anal intraepithelial neoplasia (HGAIN) in community-based cohorts of HIV-negative and HIV-positive homosexual men in Sydney, Australia. Methods: A cross-sectional study of consecutive participants in both cohorts was performed in 2005 (204 HIV-negative and 128 HIV-positive men). Anal swabs collected by a research nurse underwent cytological analysis, using the ThinPrep procedure, and human papillomavirus (HPV) testing. Participants who had cytological abnormalities other than low-grade squamous epithelial lesions (SIL) were referred for high resolution anoscopy (HRA). Results: A total of 114 men had cytological abnormalities (24.3% of HIV-negative and 57.5% of HIV-positive men, odds ratio (OR) = 4.21, 95% confidence interval (CI) 2.57–6.90). However, only three (2.3%) HIV-positive men and no HIV-negative men had high-grade SIL on anal cytology. Seventy-seven men were referred for HRA, of whom 63 (81.8%) attended. Histologically confirmed HGAIN was detected in 21 (33.3%). The prevalence of HGAIN was higher in HIV-positive men (10.8%) than in HIV-negative men (5.0%, OR = 2.29, 95% CI 0.93–5.63, P = 0.071). HGAIN was not related to age but was strongly associated with the detection of high-risk types of anal HPV (OR = 10.1, 95% CI 1.33–76.2) rather than low-risk types (OR = 1.97, 95% CI 0.74–5.25). Conclusion: HGAIN was prevalent in homosexual men across all age groups and was more than twice as common in HIV-positive men compared with HIV-negative men. The presence of high-risk anal HPV was highly predictive of HGAIN.

Additional keywords: Australia, HPV, risk factor.


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