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Prolonged antiretroviral therapy is associated with fewer anal high-grade squamous intraepithelial lesions in HIV-positive MSM in a cross-sectional study
  1. Agnès Libois1,
  2. Francesco Feoli2,
  3. Marcel Nkuize3,
  4. Marc Delforge1,
  5. Deborah Konopnicki1,
  6. Nathan Clumeck1,
  7. Stéphane De Wit1
  1. 1Department of Infectious Diseases, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
  2. 2Department of Pathology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
  3. 3Department of Gastroenterology, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
  1. Correspondence to Dr Agnès Libois, Department of Infectious Diseases, University Saint-Pierre Hospital, 322 rue haute, Bruxelles 1000, Belgium; agnes_libois{at}


Objective HIV-positive men who have sex with men (MSM) are at increased risk of anal cancer. We evaluate the risk factors for anal high-grade squamous intraepithelial lesion (HSIL) (the precursor of anal cancer) in HIV-positive MSM.

Methods In this cross-sectional study within a cohort, 320 HIV-positive MSM were screened by anal cytology followed by high-resolution anoscopy (HRA) in case of abnormal cytology. Risk factors for anal HSIL were analysed.

Results Men were mostly middle-aged Caucasians with median CD4+ T lymphocytes of 638 cells/µL, 87% on combined antiretroviral therapy (cART) for a median of 5 years. 198 anal cytology samples were normal. In the 122 patients with abnormal cytology, HRA with biopsies were performed: 12% (n=15) normal, 36% (n=44) anal low-grade squamous intraepithelial lesion (LSIL) and 51% (n=63) anal HSIL. Comparing patients with or without anal HSIL (normal cytology or normal biopsy or LSIL), we found in multivariate analysis significantly fewer anal HSIL in patients with cART ≥24 months (OR 0.32 CI 95% 0.162 to 0.631, p=0.001).

Conclusions Prolonged cART (≥24 months) is associated with fewer anal HSIL.

  • HIV
  • HPV

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  • Part of this study was presented at the 14th European AIDS Conference in Brussels, 16–19 October 2013, oral presentation (Abstract PS6/3).

  • Handling editor Jackie A Cassell

  • Contributors AL conceived the study, participated in the data collection and wrote the article, with the input of SDW. FF analysed anal cytology and histology, MN performed HRA, MD conducted data collection, data management and performed statistical analysis. All authors contributed to the final draft and approved it.

  • Competing interests None declared.

  • Ethics approval Ethics Committee of Saint-Pierre University Hospital, Brussels. No. O.M. 007.

  • Provenance and peer review Not commissioned; externally peer reviewed.