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J Infect Dis. 2010 Nov 15;202(10):1567-76. doi: 10.1086/656775. Epub 2010 Oct 6.

Factors associated with prevalent abnormal anal cytology in a large cohort of HIV-infected adults in the United States.

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  • 1National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. ljc2@cdc.gov

Abstract

BACKGROUND:

The prevalence of and risk factors for abnormal anal cytology among men and women with human immunodeficiency virus (HIV) infection have not been extensively investigated.

METHODS:

The Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN study) is a prospective cohort study of HIV-infected patients in 4 US cities. Baseline questionnaires were administered and anal samples for cytology and human papillomavirus (HPV) detection and genotyping were collected.

RESULTS:

Among 471 men and 150 women (median age, 41 years), 78% of participants were receiving combination antiretroviral therapy, 41% had a CD4(+) cell count of ≥500 cells/μL, and 71% had an HIV RNA viral load of <400 copies/mL. The anal cytology results were as follows: 336 participants (54%) had negative results, 96 participants (15%) had atypical squamous cells, 149 participants (24%) had low-grade squamous intraepithelial lesions, and 40 participants (6%) had high-grade squamous intraepithelial lesions. In a multivariate analysis, abnormal anal cytology was associated with number of high-risk and low-risk HPV types (adjusted odds ratio [AOR] for both, 1.28; P < .001), nadir CD4(+) cell count of <50 cells/μL (AOR, 2.38; P = .001), baseline CD4(+) cell count of <500 cells/μL (AOR, 1.75; P = .004), and ever having receptive anal intercourse (AOR, 2.51; P < .001).

CONCLUSION:

HIV-infected persons with multiple anal HPV types or a nadir CD4(+) cell count of <50 cells/μL have an increased risk for abnormal anal cytology.

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