Determinants of high-grade anal intraepithelial lesions in HIV-positive men having sex with men

Abstract : Objective - To assess determinants for histologically proven high-grade anal intraepithelial lesions (hHSIL) in HIV-positive MSM, a population at high-risk of HPV-related anal cancer. Design - APACHES is a prospective study of anal HPV and related-lesions in 513 HIV-positive MSM aged ≥35 in six centres across France. Methods - At baseline, participants underwent high-resolution anoscopy (HRA) with biopsy of suspicious lesions, preceded by anal swabs for liquid-based cytology, p16/Ki67 immunostaining, and HPV DNA. hHSIL diagnosis was established by histopathological review panel consensus, and determinants assessed by logistic regression. Results - Baseline hHSIL prevalence was 10.4% and did not differ significantly by age, sexual behaviour or HIV/immunodeficiency markers. hHSIL prevalence was significantly elevated in participants that smoked (ORadj = 2.6, 95%CI 1.3-5.5) or who, in concurrent anal swabs, had ASCUS/LSIL (3.6, 95% CI 1.4-9.3) or ASC-H/HSIL (22.2, 95% CI 6.8-72.6) cytologic abnormalities, p16/Ki67 dual positivity (3.4, 95%CI 1.5-7.5), or non-HPV16 HR (13.0, 95%CI 1.7-102), but most notably, HPV16 (46.3, 6.1-355) infection. Previous diagnosis of low- (2.3, 95%CI 1.0-5.4) or high- (3.8, 95%CI 1.5-9.9) grade anal lesion also conveyed higher hHSIL risk. After controlling for patient-specific determinants, there remained significant centre-specific effects, most clearly in higher risk groups (HPV16-positive participants: 31.3% hHSIL in centres A-D versus 5.1% in centres E-F, p < 0.01). Conclusions - Anal cytology and HPV16 infection are potentially useful determinants of hHSIL risk in HIV-positive MSM, but HIV/immunodeficiency-related variables appear not to be. Controlling for patient-specific hHSIL determinants highlights variability in HRA practice across diverse clinical settings and the need for better standardisation of this difficult procedure.
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Submitted on : Monday, August 27, 2018 - 11:27:18 AM
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Gary M Clifford, Laurent Siproudhis, Lionel Piroth, Isabelle Poizot-Martin, Sylvie Radenne, et al.. Determinants of high-grade anal intraepithelial lesions in HIV-positive men having sex with men. AIDS, Lippincott, Williams & Wilkins, 2018, 32 (16), pp.2363-2371. ⟨10.1097/QAD.0000000000001947⟩. ⟨hal-01862284⟩

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