658

HIV men who have sex with men

23 6 15
23 8 2

Key words : human immunodeficiency virusHIV,anal cancer, anal pap smear

HIV men who have sex with menMSM

2010 4 2011 3 HIV
HIV MSM 81

41 50.613 16.0 atypical squamous

cells24 29.6 low-grade squamous intraepithelial lesions3 3.7 high-grade
squamous intraepithelial lesions

OR4.19 ; p.021

HIV MSM 81 40 49.4

856586632011

Human immunodeficiency virusHIV

HIV

HIV MSM 81

HIV human papillomavirusHPV

HIV 10

25144 HIV

35 HIV men who have sex

HIV MSM

with menMSMHIV MSM

25 HIV

anal intraepithelial neoplasiaAIN

2010 4 2011 3

HIV 1

1620065 828
BSTEP 2

HIV MSM 143

81
56.6
85 6

HIV

659

Table1Anal cytology test result

Lesion status

Cases (%)

NILM

41 (50.6)

ASCUS

13 (16.0)

LSIL

24 (29.6)

HSIL

3 ( 3.7)

1
38.2 7.0 HIV

NILM: negative for intraep-

1,972.0 1,320.0 20

ithelial lesion or malignancy

24.7
40 49.4
nadir

ASCUS: atypical squamous

CD4 179.5 75.4!

L CD4

cells of undetermined sig-

489.0 201.5!
LHIV 73
90.1

nificance
LSIL: low-grade squamous
intraepithelial lesion

50 !
mL 6
52 64.2

HSIL: high-grade squamous

intraepithelial lesion

2
Table 1

40 49.4

41 50.6

ASCUS LSIL

high resolution anoscopyHRA

5cm

HSIL

3 2

2001

Table 2

nadir

CD4 CD4 6

4.1995CI

atypical

3.36

squamous cells of undetermined significanceAS-

0.46-

CUS
low-grade squamous intraepithelial lesion

LSIL
high-grade squamous intraepithelial lesion

2003 548

HSIL
negative for in-

1,540

traepithelial lesion or malignancyNILM

17.2
226 14.7

HIV

1983

2010 4

HIV

6,973 HIV

Multicenter AIDS Cohort Study

19841995 HIV

PASW

18

10 69 19962006

IBMChicagoIllinoisp.05

HIV 137 9,429

5
231120

statistics

HIV Swiss

HIV

Cohort

Study 19851996 10 8.3

660

Table2Logistic regression multivariate analysis of factors associated with normal and abnormal anal cytology
Control:
normal cytology
NILM
n41

Risk factor

Age

Case:
abnormal cytology
ASC-US, HSIL, LSIL
n40

Odds
ratio

95% CI

39.07.4

37.46.6

0.666

n.s.

0.99

0.92-1.01

Current CD4 (/L)

552.4206.2

539.6199.0

0.895

n.s.

1.00

1.00-1.00

Nadir CD4 (/L)

0.99-1.00

181.269.5

164.580.7

0.209

n.s.

0.99

Genital condyloma history

5, 12.2%

15, 37.5%

0.021

4.19

0.46-3.36

Current cigarette smoker

14, 34.1%

16, 40.0%

0.954

n.s.

1.03

0.38-2.76

Receptive anal intercourse within the last 6 months

24, 58.5%

28, 70.0%

0.671

n.s.

1.24

0.46-3.36

CI: confidence interval: meanSD: n, %n.s.: not significant: p .05

Table3Studies evaluating abnormal cytology prevalence in HIV-positive MSM cohorts

Subjects with cytological dysplasia (%)

Study

Reference

Year

Location

Subjects

Friedman HB et al.
Goldstone SE et al.
Lee A et al.
Palefsky JM et al.

15
16
17
18

1998
2001
2004
2004

Multicenter AIDS cohort

New York, NY, USA
San Francisco, CA, USA
San Francisco, CA, USA

100
131
417
347

40
4
189
33

Li AH et al.
Kreuter A et al.

19
20

2009
2010

Bang Kok, Thailand

Germany

118
446

78 (66.1)
116 (26.0)

NILM
(40.0)
( 3.1)
(45.3)
( 9.5)

ASCUS
20
10
121
23

(20.0)
( 7.6)
(29.0)
( 6.6)

19 (16.1)

LSIL

HSIL

40 (40.0)
42 (32.1)
75 (57.3)
85 (20.4)
18 ( 4.3)
101 (29.1) 180 (51.9)
17 (14.4)
4 ( 3.4)
163 (36.5) 156 (35.0)

Anal cancer

4 (1.0)

11 (2.5)

Combined cytological and histological examination results conducted simultaneously. The more severe diagnosis is shown.
Note: Abbreviations are the same as in Table 1.

19972001 42.7

49.4

20022006 25.3

33.997.0

AIN

MSM

Palefsky JM

HIV HIV MSM

LSIL HIV 346 62 2

10 69144

HSIL

HIV

Scholefield JH AIN 3

35 3 8.6

63 Watson AJ

72 AIN 1996

2004 8

16!
18

HPV

AIN cer-

vical intraepithelial neoplasiaCIN

AIN

20

AIN HPV

25 1
50

HPV

2
3

HIV 10

CIN LSIL

HPV 7

AIN1HSIL AIN2 3

HPV

MSM
AIN

Table 3

Nadir CD4
85 6

HIV

Fig.1Protocol for anal intraepithelial neoplasia

(AIN) screening

661

HPV

HRA

HIV MSM 81

24 2010
11

AIN

HRA
AIN

Chin-Hong PV
HIV AIN
Fig. 1
HRA
AIN HRA

HRA AIN
85 trichloracetic acid

imiquimod

HIV
4 HPV

HIV MSM
1 1

HRA

HRA
6993 3259
HRA
HPV
HPV

HPV
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1Engels EANon-AIDS-defining malignancies in

HIV-infected persons : etiologic puzzles, epidemiologic perils, prevention opportunities. AIDS

20092387585.
2Franceschi S, Lise M, Clifford GM, Rickenbach
M, Levi F, Maspoli M, et al.Changing patterns
of cancer incidence in the early- and lateHAART periods : the Swiss HIV Cohort Study.
Br J Cancer 201010341622.
3Diamond C, Taylor TH, Aboumrad T, Bringman
D, Anton-Culver HIncreased incidence of
squamous cell anal cancer among men with
AIDS in the era of highly active antiretroviral
therapy. Sex Transm Dis 20053231420.
4D Souza G, Wiley DJ, Li X, Chmiel JS, Margolick
JB, Cranston RD, et al.Incidence and epidemiology of anal cancer in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr
2008484919.
5Piketty C, Selinger-Leneman H, Grabar S, Duvivier C, Bonmarchand M, Abramowitz L, et
al.Marked increase in the incidence of invasive anal cancer among HIV-infected patients
despite treatment with combination antiretroviral therapy. AIDS 200822120311.
6Crum-Cianflone NF, Hullsiek KH, Marconi VC,
Ganesan A, Weintrob A, Barthel RV, et al.
Anal cancers among HIV-infected persons :
HAART is not slowing rising incidence. AIDS
20102453543.
7Chin-Hong PV, Palefsky JMNatural history
and clinical management of anal human papillomavirus disease in men and women infected
with human immunodeficiency virus. Clin Infect
Dis 200235112734.
8
HIV

200760824.
9
59

662

20055841521.
10
HIV
200364

875.
11
HIV
1 2006
6716215.
12
HIV
1 2010372656
8.
13
STD
2006598226.
14Bean SM, Chhieng DCAnal-rectal cytology : a
review. Diagn Cytopathol 20103853846.
15Friedman HB, Saah AJ, Sherman ME, Busseniers AE, Blackwelder WC, Kaslow RA, et al.
Human papillomavirus, anal squamous intraepithelial lesions, and human immunodeficiency virus in a cohort of gay men. J Infect Dis 1998
1784552.
16Goldstone SE, Winkler B, Ufford LJ, Alt E, Palefsky JMHigh prevalence of anal squamous intraepithelial lesions and squamous-cell carcinoma in men who have sex with men as seen in
a surgical practice. Dis Colon Rectum 2001
446908.
17Lee A, Young T, Hanks D, Ung R, Stansell J
The evaluation of anal dysplasia with anal cytology (PAP) followed by high resolution anoscopy
(HRA) and biopsy in HIV-infected men. 15th Int
Conf AIDS Bangkok, Thailand 2004.
18Palefsky JM, Holly EA, Hogeboom CJ, Ralston
ML, DaCosta MM, Botts R, et al.Virologic, immunologic, and clinical parameters in the incidence and progression of anal squamous intraepithelial lesions in HIV-positive and HIVnegative homosexual men. J Acquir Immune
Defic Syndr Hum Retrovirol 1998173149.
19Li AH, Phanuphak N, Sahasrabuddhe VV,
Chaithongwongwatthana S, Vermund SH,
Jenkins CA, et al.Anal squamous intraepithelial lesions among HIV positive and HIV nega-

tive men who have sex with men in Thailand.

Sex Transm Infect 2009855037.
20Kreuter A, Potthoff A, Brockmeyer NH, Gambichler T, Swoboda J, Stucker M, et al.Anal carcinoma in human immunodeficiency viruspositive men : results of a prospective study
from Germany. Br J Dermatol 2010162
126977.
21Palefsky JM, Holly EA, Hogeboom CJ, Ralston
ML, DaCosta MM, Botts R, et al.Virologic, immunologic, and clinical parameters in the incidence and progression of anal squamous intraepithelial lesions in HIV-positive and HIVnegative homosexual men. J Acquir Immune
Defic Syndr Hum Retrovirol 1998173149.
22Scholefield JH, Castle MT, Watson NFMalignant transformation of high-grade anal intraepithelial neoplasia. Br J Surg 20059211336.
23Watson AJ, Smith BB, Whitehead MR, Sykes
PH, Frizelle FAMalignant progression of anal
intra-epithelial neoplasia. ANZ J Surg 2006
767157.
24Wilkin TJ, Palmer S, Brudney KF, Chiasson
MA, Wright TCAnal intraepithelial neoplasia
in heterosexual and homosexual HIV-positive
men with access to antiretroviral therapy. J Infect Dis 2004190168591.
25Daling JR, Madeleine MM, Johnson LG,
Schwartz SM, Shera KA, Wurscher MA, et al.
Human papillomavirus, smoking, and sexual
practices in the etiology of anal cancer. Cancer
200410127080.
26

HPV
HIV HPV
20116411
6.
27Wilkin T, Lee JY, Lensing SY, Stier EA, Goldstone SE, Berry JM, et al.Safety and immunogenicity of the quadrivalent human papillomavirus vaccine in HIV-1-infected men. J Infect Dis
2010202124653.
28Chiao EY, Giordano TP, Palefsky JM, Tyring S,
El Serag HScreening HIV-infected individuals
for anal cancer precursor lesions : a systematic
review. Clin Infect Dis 20064322333.

85 6

HIV

663

Japanese HIV-infected Men who Have Sex with Men Screened for Anal Intraepithelial Neoplasia
Ichiro ITODA & Hiroshi KITAMURA
1)

2)

Shirakaba Clinic, Department of Internal Medicine, Medical Oncology School of Medicine, Kyorin University

The prevalence of and the risk factors for abnormal anal cytology among Japanese men who have sex
with men (MSM) who have human immunodeficiency virus (HIV) infection have not been fully investigated
up to now.
We conducted a nested case-control study of 81 HIV-infected Japanese MSM treated with antiretroviral
therapy at a sexuality minority affirmative clinic between April 2010 and March 2011.
Results showed that 41 (50.6) of the 81 had normal anal cytology, 13 (16.0) atypical squamous cells,
24 (29.6) low-grade squamous intraepithelial lesions, and 3 (3.7) high-grade squamous intraepithelial lesions. No carcinoma cases were seen. Multivariate analysis showed abnormal anal cytology to be associated
with a history of genital condyloma (OR 4.19, p.021).
We concluded that abnormal anal cytology was common among HIV-infected Japanese MSM. Effective
screening and management should be planned for precancerous anal lesions.

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