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RESEARCH ARTICLE

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

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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