HIV status predicts anal dysphasia and carcinoma risk in HPV-infected individuals

Among patients infected with human papillomavirus (HPV), the prevalence of anal high-grade dysplasia and carcinoma is higher among individuals who are also infected with HIV, according to a report published in the March issue of Gastroenterology.

Dr. Iradj Sobhani and colleagues from the Hopital Bichat Claude-Bernard in Paris prospectively followed 174 consecutive patients with anal canal condyloma cured by excision. Of the group, 114 subjects were HIV-positive and 60 were HIV-negative. Patients were followed for a median of 26 months with relapse condylomas being excised and examined histologically.

Oncogenic HPV types and other current anal infections were more common among HIV-positive than HIV-negative subjects, the researchers state. Anal tissue levels of Langerhans cells were significantly lower in the HIV-infected group. Men constituted a higher percentage of the HIV-infected group than of the non-infected group.

Seventy-five percent of HIV-positive patients experienced a condyloma relapse compared with only 6% of HIV-negative patients. Of the recurrences, only one case of high-grade dysplasia was identified in the HIV-negative group, while 19 such cases occurred in the HIV-positive group.

The independent risk factors for condyloma relapse included male sex, HIV positivity, and less than 15 Langerhans cells/mm of anal tissue. For high-grade dysplasia and cancer, the risk factors were HIV positivity, high-grade dysplasia before inclusion, and condyloma relapse. Serum HIV load correlated with the risk of relapse, but CD4+ T cell count did not.

The investigators believe that “HIV-positive patients with high serum HIV load and/or a history of anal dysplasia should be examined by anoscopy, and condylomas should be analysed histologically.” The current findings “should now be confirmed in a multicentre trial, and the putative role of HIV and tissue immune cells in anal carcinogenesis requires further investigation,” they add.

Comment

It has already been shown in studies that men who have sex with men have a higher incidence of anal carcinomas and that HIV-positivity increases the incidence further.