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Anal Cancer Precursors in Persons with HIV Infection
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What is the problem and what is known about it so far?
Anal cancer is associated with a virus (human papillomavirus, or HPV) that causes genital warts. People get the virus from unprotected sexual intercourse. The virus can produce abnormal cells (precancerous and cancerous) and is the same virus that increases the risk for cervical cancer in women. People who have reduced immunity, such as patients with HIV infection, are at increased risk for developing cancers that are related to HPV infection. Men who have receptive anal intercourse have a high incidence of anal cancer. Both HPV infection and anal cancer are more common in HIV-positive men who have sex with men than in HIV-negative homosexual men. However, little is known about HPV and anal lesions in HIV-positive men who have no history of receptive anal intercourse.
Why did the researchers do this particular study?
To determine whether anal HPV infection and precursors of anal cancer occur in HIV-positive men who have no history of sex with men.
Who was studied?
50 HIV-positive men with no history of anal intercourse and 67 HIV-positive men who had sex with men. All of the men who reported no history of anal intercourse were injection drug users.
How was the study done?
The researchers evaluated 120 HIV-positive men who were seen at an outpatient clinic in Paris, France. Fifty of the men were infected with HIV as a result of injection drug use. These men reported never having sex with men and never having receptive anal intercourse. Sixty-seven of the men were homosexuals who were infected with HIV as a result of having unprotected sex with men. All patients had anal examinations that included swabs of the anus to test for HPV and abnormal cells. If swab test results showed abnormal cells, biopsies were done. The researchers then compared numbers of people with HPV infection and anal lesions between groups.
What did the researchers find?
46% of the 50 men who reported never having sex with men had anal HPV infection, 85% of the 67 men who had sex with men had anal HPV infection, 36% of the 50 men who reported never having sex with men had precancerous anal lesions, and 72% of the 67 men who had sex with men had precancerous anal lesions. Among men who reported not having sex with men, low CD4+ cell counts (a measure of immune function in HIV infection) were associated with increased risk for anal lesions.
What were the limitations of the study?
Some patients with HIV infection from injection drug use may have misrepresented their history of anal intercourse. Only patients whose swab test results showed abnormal cells had biopsies to look for cancerous lesions. A few of the swab test results could have been falsely negative and a few abnormal lesions could have been missed.
What are the implications of the study?
Anal HPV infection and associated precancerous lesions occur in the absence of receptive anal intercourse in HIV-positive men.
Article and Author Information
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The summary below is from the full report titled “High Prevalence of Anal Human Papillomavirus Infection and Anal Cancer Precursors among HIV-Infected Persons in the Absence of Anal Intercourse.” It is in the 18 March 2003 issue of Annals of Internal Medicine (volume 138, pages 453-459). The authors are C Piketty, TM Darragh, M Da Costa, P Bruneval, I Heard, MD Kazatchkine, and JM Palefsky.
- Copyright ©2004 by the American College of Physicians
