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Sex Transm Infect. Jun 1999; 75(3): 172–177.
PMCID: PMC1758206

A study of anal intraepithelial neoplasia in HIV positive homosexual men


OBJECTIVES: To determine the prevalence of high grade anal intraepithelial neoplasia (HGAIN), the value of anal cytology in screening for HGAIN, and the characterisation of epidemiological factors and human papillomavirus (HPV) types. METHODS: Prospective cohort study of HIV positive homosexual men. Subjects were interviewed, underwent STD, anal cytological, and HPV screening at enrolment and at subsequent follow up visits with anoscopy and biopsy at the final visit. 57 enrolled, average CD4 count 273 x 10(6)/l (10-588); 41 completed the cytological surveillance over the follow up period (181 visits, average follow up 17 months), 38 of these had anoscopy and anal biopsy. RESULTS: Oncogenic HPV types were detected in 84% and high grade dyskaryosis in 10.5% (6/57) at enrollment. There was a 70% incidence of high grade dyskaryosis during follow up in patients with negative/warty or low grade dyskaryosis at enrollment. Anoscopy correlated with histology in high grade AIN lesions (sensitivity 91%, specificity 54%) and cytology was 78% sensitive (18/23) for HGAIN on biopsy. CONCLUSIONS: AIN and infection with multiple oncogenic HPV types are very common among immunosuppressed HIV positive homosexual men. Apparent progression from low to high grade cytological changes occurred over a short follow up period, with no cases of carcinoma. All 23 cases of HGAIN were predicted by cytology and/or anoscopy. Future studies focusing on the risk of progression to carcinoma are needed before applying anal cytology as a screening tool for AIN in this population.

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Selected References

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  • Kjaer SK, van den Brule AJ, Bock JE, Poll PA, Engholm G, Sherman ME, Walboomers JM, Meijer CJ. Human papillomavirus--the most significant risk determinant of cervical intraepithelial neoplasia. Int J Cancer. 1996 Mar 1;65(5):601–606. [PubMed]
  • Rozendaal L, Walboomers JM, van der Linden JC, Voorhorst FJ, Kenemans P, Helmerhorst TJ, van Ballegooijen M, Meijer CJ. PCR-based high-risk HPV test in cervical cancer screening gives objective risk assessment of women with cytomorphologically normal cervical smears. Int J Cancer. 1996 Dec 11;68(6):766–769. [PubMed]
  • Palefsky JM, Gonzales J, Greenblatt RM, Ahn DK, Hollander H. Anal intraepithelial neoplasia and anal papillomavirus infection among homosexual males with group IV HIV disease. JAMA. 1990 Jun 6;263(21):2911–2916. [PubMed]
  • van den Brule AJ, Snijders PJ, Gordijn RL, Bleker OP, Meijer CJ, Walboomers JM. General primer-mediated polymerase chain reaction permits the detection of sequenced and still unsequenced human papillomavirus genotypes in cervical scrapes and carcinomas. Int J Cancer. 1990 Apr 15;45(4):644–649. [PubMed]
  • Zaki SR, Judd R, Coffield LM, Greer P, Rolston F, Evatt BL. Human papillomavirus infection and anal carcinoma. Retrospective analysis by in situ hybridization and the polymerase chain reaction. Am J Pathol. 1992 Jun;140(6):1345–1355. [PMC free article] [PubMed]
  • Palefsky JM, Holly EA, Gonzales J, Berline J, Ahn DK, Greenspan JS. Detection of human papillomavirus DNA in anal intraepithelial neoplasia and anal cancer. Cancer Res. 1991 Feb 1;51(3):1014–1019. [PubMed]
  • Palefsky JM, Holly EA, Ralston ML, Jay N, Berry JM, Darragh TM. High incidence of anal high-grade squamous intra-epithelial lesions among HIV-positive and HIV-negative homosexual and bisexual men. AIDS. 1998 Mar 26;12(5):495–503. [PubMed]
  • Critchlow CW, Surawicz CM, Holmes KK, Kuypers J, Daling JR, Hawes SE, Goldbaum GM, Sayer J, Hurt C, Dunphy C, et al. Prospective study of high grade anal squamous intraepithelial neoplasia in a cohort of homosexual men: influence of HIV infection, immunosuppression and human papillomavirus infection. AIDS. 1995 Nov;9(11):1255–1262. [PubMed]
  • Palefsky JM, Shiboski S, Moss A. Risk factors for anal human papillomavirus infection and anal cytologic abnormalities in HIV-positive and HIV-negative homosexual men. J Acquir Immune Defic Syndr. 1994 Jun;7(6):599–606. [PubMed]
  • Palefsky JM, Holly EA, Ralston ML, Jay N. Prevalence and risk factors for human papillomavirus infection of the anal canal in human immunodeficiency virus (HIV)-positive and HIV-negative homosexual men. J Infect Dis. 1998 Feb;177(2):361–367. [PubMed]
  • Melbye M, Coté TR, Kessler L, Gail M, Biggar RJ. High incidence of anal cancer among AIDS patients. The AIDS/Cancer Working Group. Lancet. 1994 Mar 12;343(8898):636–639. [PubMed]
  • Goedert JJ, Coté TR, Virgo P, Scoppa SM, Kingma DW, Gail MH, Jaffe ES, Biggar RJ. Spectrum of AIDS-associated malignant disorders. Lancet. 1998 Jun 20;351(9119):1833–1839. [PubMed]
  • Palefsky JM, Holly EA, Gonzales J, Lamborn K, Hollander H. Natural history of anal cytologic abnormalities and papillomavirus infection among homosexual men with group IV HIV disease. J Acquir Immune Defic Syndr. 1992 Dec;5(12):1258–1265. [PubMed]
  • Ostör AG. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol. 1993 Apr;12(2):186–192. [PubMed]
  • Syrjänen KJ. Spontaneous evolution of intraepithelial lesions according to the grade and type of the implicated human papillomavirus (HPV). Eur J Obstet Gynecol Reprod Biol. 1996 Mar;65(1):45–53. [PubMed]
  • de Roda Husman AM, Walboomers JM, van den Brule AJ, Meijer CJ, Snijders PJ. The use of general primers GP5 and GP6 elongated at their 3' ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR. J Gen Virol. 1995 Apr;76(Pt 4):1057–1062. [PubMed]
  • Soler C, Allibert P, Chardonnet Y, Cros P, Mandrand B, Thivolet J. Detection of human papillomavirus types 6, 11, 16 and 18 in mucosal and cutaneous lesions by the multiplex polymerase chain reaction. J Virol Methods. 1991 Nov-Dec;35(2):143–157. [PubMed]
  • van den Brule AJ, Meijer CJ, Bakels V, Kenemans P, Walboomers JM. Rapid detection of human papillomavirus in cervical scrapes by combined general primer-mediated and type-specific polymerase chain reaction. J Clin Microbiol. 1990 Dec;28(12):2739–2743. [PMC free article] [PubMed]
  • Vandenvelde C, Scheen R, Van Pachterbeke C, Loriaux C, Decelle J, Hubert T, Delhaye C, Cattoor JP, Duys M, Van Beers D. Prevalence of high risk genital papillomaviruses in the Belgian female population determined by fast multiplex polymerase chain reaction. J Med Virol. 1992 Apr;36(4):279–282. [PubMed]
  • de Ruiter A, Carter P, Katz DR, Kocjan G, Whatrup C, Northover J, Mindel A. A comparison between cytology and histology to detect anal intraepithelial neoplasia. Genitourin Med. 1994 Feb;70(1):22–25. [PMC free article] [PubMed]
  • Palefsky JM, Holly EA, Hogeboom CJ, Berry JM, Jay N, Darragh TM. Anal cytology as a screening tool for anal squamous intraepithelial lesions. J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Apr 15;14(5):415–422. [PubMed]
  • Carter PS, de Ruiter A, Whatrup C, Katz DR, Ewings P, Mindel A, Northover JM. Human immunodeficiency virus infection and genital warts as risk factors for anal intraepithelial neoplasia in homosexual men. Br J Surg. 1995 Apr;82(4):473–474. [PubMed]
  • Sherman ME, Schiffman MH, Erozan YS, Wacholder S, Kurman RJ. The Bethesda System. A proposal for reporting abnormal cervical smears based on the reproducibility of cytopathologic diagnoses. Arch Pathol Lab Med. 1992 Nov;116(11):1155–1158. [PubMed]
  • Carter PS, Sheffield JP, Shepherd N, Melcher DH, Jenkins D, Ewings P, Talbot I, Northover JM. Interobserver variation in the reporting of the histopathological grading of anal intraepithelial neoplasia. J Clin Pathol. 1994 Nov;47(11):1032–1034. [PMC free article] [PubMed]
  • Vermund SH, Kelley KF, Klein RS, Feingold AR, Schreiber K, Munk G, Burk RD. High risk of human papillomavirus infection and cervical squamous intraepithelial lesions among women with symptomatic human immunodeficiency virus infection. Am J Obstet Gynecol. 1991 Aug;165(2):392–400. [PubMed]
  • Northfelt DW, Swift PS, Palefsky JM. Anal neoplasia. Pathogenesis, diagnosis, and management. Hematol Oncol Clin North Am. 1996 Oct;10(5):1177–1187. [PubMed]
  • Maiman M, Fruchter RG, Serur E, Levine PA, Arrastia CD, Sedlis A. Recurrent cervical intraepithelial neoplasia in human immunodeficiency virus-seropositive women. Obstet Gynecol. 1993 Aug;82(2):170–174. [PubMed]

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