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PLoS One. 2013 Dec 18;8(12):e84030. doi: 10.1371/journal.pone.0084030. eCollection 2013.

Risk Factors for the presence of anal intraepithelial neoplasia in HIV+ men who have sex with men.

Author information

1
Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands ; Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands.
2
Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands ; Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands ; STI outpatient clinic, Cluster for Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.
3
Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
4
Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands.

Abstract

OBJECTIVE:

Anal Intraepithelial Neoplasia (AIN) is present in the majority of HIV+ men who have sex with men (MSM) and routine AIN-screening is subject of discussion. In this study we analysed a wide range of potential risk factors for AIN in order to target screening programs.

METHODS:

We screened 311 HIV+ MSM by high resolution anoscopy, with biopsies of suspect lesions. HIV-parameters, previous sexual transmitted infections (STI's), anal pathology, sexual practices and substance use were analysed in relation to AIN by uni- and multivariable logistic regression.

RESULTS:

AIN (any grade) was found in 175/311 MSM (56%), high grade (HG)AIN in 30%. In the univariable analysis, years since HIV diagnosis, years of antiretroviral therapy (cART) and anal XTC use decreased AIN risk, while a history of anogenital warts and use of GHB (γ-hydroxybutyric acid) increased this risk. In the multivariable analysis three parameters remained significant: years of cART (OR=0.92 per year, p=0.003), anal XTC use (OR=0.10, p=0.002) and GHB use (OR=2.60, p=0.003). No parameters were significantly associated with HGAIN, but there was a trend towards increased risk with anal enema use prior to sex (>50 times ever; p=0.07) and with a history of AIN (p=0.06). CD4 count, STI's, anal pathology, smoking, number of sex partners and anal fisting were not associated with (HG)AIN.

CONCLUSION:

GHB use increases the risk for AIN, while duration of cART and anal XTC use are negatively correlated with AIN. Given the high prevalence of AIN in HIV+ MSM, these associations are not helpful to guide a screening program.

PMID:
24367625
PMCID:
PMC3867484
DOI:
10.1371/journal.pone.0084030
[Indexed for MEDLINE]
Free PMC Article

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