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M9650323.TXT
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1996-03-09
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Document 0323
DOCN M9650323
TI Prospective study of high grade anal squamous intraepithelial neoplasia
in a cohort of homosexual men: influence of HIV infection,
immunosuppression and human papillomavirus infection.
DT 9605
AU Critchlow CW; Surawicz CM; Holmes KK; Kuypers J; Daling JR; Hawes SE;
Goldbaum GM; Sayer J; Hurt C; Dunphy C; et al; Department of
Epidemiology, School of Public Health and Community; Medicine,
University of Washington, Seattle 98195, USA.
SO AIDS. 1995 Nov;9(11):1255-62. Unique Identifier : AIDSLINE MED/96126180
AB OBJECTIVE: To determine the risk of developing high grade anal squamous
intraepithelial neoplasia (HG-AIN) in relation to HIV infection and
immunosuppression, after controlling for the effects of human
papillomavirus (HPV) infection. DESIGN: Prospective cohort study of 158
HIV-seropositive and 147 HIV-seronegative homosexual men presenting to a
community-based clinic with initially negative anal cytologic and
colposcopic findings. METHODS: Subjects completed self-administered
questionnaires, underwent cytologic screening, and standardized unaided
and colposcopic examination of the proximal anal canal for presence of
abnormalities suggestive of AIN. Anal specimens were screened for HPV
DNA. RESULTS: HG-AIN developed in eight (5.4%) and 24 (15.2%)
HIV-seronegative and -seropositive men, respectively. Risk of HG-AIN
among HIV-seronegative men was associated with detection of anal HPV
types 16 or 18 by Southern transfer hybridization (STH), detection of
HPV 16 or 18 at the lower levels by polymerase chain reaction but not by
STH, and with number of positive HPV tests; HG-AIN risk among
HIV-seropositive men was associated with detection of HPV 16 or 18 only
by STH, detection of HPV types other than 16 or 18, CD4 count < or = 500
x 10(6)/l, and number of positive HPV tests. HIV-induced
immunosuppression remained an independent predictor of HG-AIN after
adjusting for type and level of detection of HPV; HIV infection
predicted HG-AIN risk after adjustment for number of positive HPV tests.
CONCLUSIONS: The association of HG-AIN with HIV, independent of HPV
type, level of HPV detection and number of positive HPV tests, suggests
that this increased risk cannot be entirely explained by an effect of
HIV on HPV detection. Future studies focusing on factors more specific
to the local microenvironment in the anal canal should help clarify
these issues.
DE Adult Anus Neoplasms/*ETIOLOGY Cohort Studies Homosexuality, Male
Human HIV Infections/*COMPLICATIONS Immunosuppression/*ADVERSE EFFECTS
Male Neoplasms, Squamous Cell/*ETIOLOGY *Papillomavirus, Human
Papovaviridae Infections/*COMPLICATIONS Prospective Studies Risk
Factors Support, U.S. Gov't, P.H.S. Tumor Virus
Infections/*COMPLICATIONS JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).