Background: Men who have sex with men (MSM), especially HIV-infected, have an increased risk of anal human papilloma virus (HPV) infection and associated lesions. Anal cytology screening is yet to be implemented as a routine in Uruguay and there's no previous data of anal HPV infection prevalence in MSM. Our objective is to determine HPV and anormal citology prevalence in anal samples from HIV-infected and non-infected MSM.
Material and method: A cross-sectional study including MSM over 18 years. Exclusion criteria: vaccinated against HPV and HPV-associated lesions previously diagnosed. Anal visual inspection is performed and 2 samples are taken from the anal canal for Pap cytology technique (Bethesda Classification 2001), molecular diagnosis and genotyping of HPV. Patients with abnormal inspection or anal cytology are referred for anoscopy and eventual biopsy.
Results: During the first 2 years of implementation: 102 patients were included. Median age: 34 years. Median age of first sexual intercourse: 18 years. Average number of sexual partners in the last six months: 14.5. 29 (76.3%) were HIV-positive, all on antiretroviral therapy, with median CD4 620/mm3 and 23 (79.3%) with suppressed viral load. Anal inspection was abnormal in 14 (36.8%) patients. 27 patients had a pathological cytology: 14 (36.8%) ASCUS, 12 (31.6%) LSIL, 1 (2.6%) HSIL, 9 (23.7%) had normal cytology. 2 samples were unrepresentative. The molecular diagnosis of HPV was positive in 23 (65.8%) patients, negative in 6 (17.1%) and unrepresentative in 6 (17.1%). The genotypes found in 11 patients were: 6, 11, 16, 18 and 54. Anoscopy was performed in 15 (55.5%) of 27 patients with indication for it: 9 without macroscopic alteration and 6 pathological (condilomatosis). HPV detection was positive in 18 (78.35) HIV-infected patients, and 5 (21.7%) HIV non-infected patients (p 0.555). Cytology was abnormal in 23 (85.2%) HIV-positive patients (14.8%) and 4 HIV-negative (p 0.064).
Conclusions:
A high prevalence of HPV infection and pathological anal cytology was found in the population studied, especially in HIV infected patients. These results are similar to the ones found in international data, and will help to develop national strategies of prevention through the implementation of screening.
