High risk of anal intraepithelial neoplasia in HIV positive men who have sex with men in Mexico
Background: Human papillomavirus (HPV) prevalence is an important health issue for HIV-positive and -negative MSM. This study assessed the prevalence of and factors associated with HPV infection and anal intraepithelial lesions among HIV-positive and -negative MSM in Mexico.
Methods: One hundred and fourteen MSM 18-59 years old were recruited in Cuernavaca, Mexico, including 48 HIV-positive men. A high-resolution anoscopy was performed on all subjects to detect anal intraepithelial neoplasia (AIN). HPV was determined independently in three different anogenital sites. Reverse hybridization was used to identify 37 HPV types (24 low-risk and 13 high-risk types). Multiple logistic regression models evaluated associated factors.
Results: Global HPV prevalence was 71.9%, with 65.7% in the anal canal, 58.7% in the perianal region and 44.7% on the penis. The prevalence of HPV 16 and 18 in the anal canal was 24.6%, which is three times higher than on the penis (7.9%), and double that in the perianal region (14.0%). Frequency of AIN grade 2 and grade 3 was 8.7% and 13.2%, respectively. Risk factors associated with AIN grades ³2 were: infection with high-risk HPV (OR 3.2; 95% CI 1.1-9.8); receptive sexual intercourse with other men (OR 3.3; 95% CI 1.2-8.9), HIV seropositivity (OR 3.9; 95% CI 1.2-12.2); HPV 16 and/or 18 in the anal canal (OR 5.9; CI 95% 2.1-16.8); having both HIV and multiple infection with five or more HPV genotypes (OR 10.1; 95% CI 1.9-52.5); and having a CD4 cell count <200 (OR 11.4; 95% CI 2.1-61.1).
Conclusions: The frequency of HPV in the anogenital region in Mexican MSM and prevalence of high-risk HPV (types 16 and 18) in the anal canal are high. There was greater risk of AIN grades ³2 among HIV positive MSM, especially those who have high-risk HPV types, multiple HPV infections or a low CD4 cell count.
-Abstract available at link below-