Article Text

Download PDFPDF
Short report
Anal dysplasia and HIV shedding in ART-treated men
  1. Yoojin Choi1,
  2. Irving Salit2,
  3. Sarah Grech1,
  4. Marie Sano2,
  5. Edward Weiss2,
  6. Colin Kovacs3,
  7. Rachelle Paquette2,
  8. Marian Claudio2,
  9. Suzanne Gibbons4,
  10. Alberto Severini4,5,
  11. Rupert Kaul1,2
  1. 1 Department of Immunology, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Medicine, University Health Network, Toronto, Ontario, Canada
  3. 3 Maple Leaf Medical Clinic, Toronto, Ontario, Canada
  4. 4 National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Winnipeg, Manitoba, Canada
  5. 5 Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Yoojin Choi, Department of Immunology, University of Toronto, Toronto, ON M4P 1A6, Canada; yoojin.choi21{at}


Objectives Anal human papillomavirus (HPV) infection is highly prevalent among men who have sex with men (MSM). HPV-associated anal dysplasia has been linked with anal HIV RNA shedding despite antiretroviral therapy (ART). Since mucosal HIV levels are a key determinant of sexual transmission of the virus, this would have important public health implications. Therefore, we assessed the association between anal dysplasia and HIV shedding in ART-treated MSM from Toronto, Canada.

Methods In 54 HIV-infected men on effective ART, we assessed anal HIV RNA shedding by PCR, HPV infection by microsphere-based genotyping and anal dysplasia by high-resolution anoscopy. All participants were enrolled between May 2017 and October 2018.

Results The median duration of ART at the time of study enrolment was 18 years, with most participants being on an integrase inhibitor-based ART regimen. Low-level anal HIV RNA shedding was present in 15/54 (27.8%) participants. Neither the detection of shedding nor the level of HIV RNA was associated with anal dysplasia, HPV infection or antiretroviral regimen.

Conclusions HPV-associated anal dysplasia was not associated with anal HIV RNA shedding in this relatively small cohort of men on effective ART. While anal HIV RNA was detected more often than anticipated, shedding was low level and unlikely to cause HIV transmission. However, the immunological drivers of anal HIV RNA shedding in ART-treated individuals may merit further study.

  • anogenital conditions
  • gay men
  • HIV
  • HPV

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Anna Maria Geretti

  • Presented at Findings from the study were presented in part at the HIV Research for Prevention (HIVR4P) conference in Madrid, Spain, on 21–25 October 2018 (Abstract).

  • Contributors IS is the principal investigator of HPV-SAVE, and RK is the principal investigator of its Immunology substudy. YC enrolled the study participants, with the help of CK for recruitment. IS, MS and EW collected research specimens with the help of RP and MC in the clinic room. YC and SG prepared the specimens, and SG and AS performed the laboratory testing. YC performed the statistical analyses. YC drafted the manuscript. All authors provided valuable input to the interpretation of data and critically reviewed the manuscript.

  • Funding This work was supported by the Canadian Institutes of Health Research (CIHR) (grant number TE2-138200 to IS).

  • Competing interests YC is supported by the Canadian Institutes of Health Research (CIHR) studentship, and RK is supported by the Ontario HIV Treatment Network (OHTN) Endowed Chair in HIV Research at the University of Toronto.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the University Health Network (16-5111) and University of Toronto (33423) Research Ethics Boards.

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

  • Data availability statement Data are available upon request.