Risk factors for anal HPV infection and anal precancer in HIV-infected men who have sex with men.

Schwartz LM, Castle PE, Follansbee S, Borgonovo S, Fetterman B, Tokugawa D, Lorey TS, Sahasrabuddhe VV, Luhn P, Gage JC, Darragh TM, Wentzensen N
J Infect Dis. 2013 208 (11): 1768-75

PMID: 23908478 · PMCID: PMC3814839 · DOI:10.1093/infdis/jit374

BACKGROUND - Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM.

METHODS - Our study included 305 MSM at an HIV/AIDS clinic in the Kaiser Permanente Northern California Health Maintenance Organization. Logistic regression was used to estimate associations of risk factors comparing men without anal HPV infection; men with anal HPV infection, but no precancer; and men with anal precancer.

RESULTS - Low CD4 count (<350 cells/mm(3)) and previous chlamydia infection were associated with an increased risk of carcinogenic HPV infection (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.28-10.40 and OR, 4.24; 95% CI, 1.16-15.51, respectively). History of smoking (OR, 2.71 95% CI, 1.43-5.14), duration, recency, and dose of smoking increased the risk of anal precancer among carcinogenic HPV-positive men but had no association with HPV infection.

CONCLUSIONS - We found distinct risk factors for anal HPV infection and anal precancer. Risk factors for HPV infection and anal precancer are similar to established risk factors for cervical cancer progression.

MeSH Terms (23)

Adolescent Adult Anal Canal Anus Neoplasms California CD4 Lymphocyte Count Chlamydia Infections Confidence Intervals Demography HIV Infections HIV Seropositivity Homosexuality, Male Humans Logistic Models Male Middle Aged Papillomaviridae Papillomavirus Infections Precancerous Conditions Risk Factors Sexual Behavior Smoking Young Adult

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