Objectives: To evaluate the prevalence and risk factors of anal squamous intraepithelial lesions (ASIL), the putative anal cancer precursor, in Asian HIV-positive and HIV-negative men who have sex with men (MSM).
Methods: Men who underwent anal Pap smear reported clinical, sociodemographic, and behavioral information collected through questionnaire and interview between January 2007 and April 2008. Chi-square test and logistic regression were used to evaluate ASIL prevalence and risk factors among HIV-positive and HIV-negative MSM.
Results: Of the 174 MSM (mean age 32.1 years), 118 (67.8%) were HIV-positive MSM. Overall, 27% had abnormal anal cytology: 13.2% had atypical squamous cells of undetermined significance (ASC-US), 11.5% had low-grade squamous intraepithelial lesion (LSIL), and 2.3% had high-grade squamous intraepithelial lesion (HSIL). Prevalence of ASIL was higher among HIV-positive than HIV-negative MSM (33.9% vs 12.5%, p=0.003). Among HIV-positive MSM, 16.1% had ASC-US, 14.4% had LSIL, and 3.4% had HSIL. These were 7.1%, 5.4%, and 0% in HIV-negative MSM, respectively. Anal condyloma was detected in 22% of HIV-positive and 16.1% (9/56) of HIV-negative MSM (p=0.5). In HIV-positive MSM, anal condyloma (OR 3.42, 95% CI 1.29 to 9.04, P=0.01) was a significant risk factor for ASIL. Highly active antiretroviral therapy (HAART) use and CD4+ T-cell count were not associated with ASIL.
Conclusions: One-third of HIV-positive and 12.5% of HIV-negative MSM had ASIL. Thus as greater numbers of HIV-positive MSM live longer due to increasing access to HAART worldwide, effective strategies to screen and manage anal precancerous lesions are needed.
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