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

Background: Identifying determinants for histologically proven high-grade anal intraepithelial lesions (hHSIL) in HIV-positive MSM would allow better targeted screening. Methods: APACHES is a prospective study of anal HPV and related-lesions in 513 HIV-positive MSM aged ≥35 in six clinics across France. 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 any 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 non16-HR HPV (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 clinic-specific effects, especially in higher risk groups (HPV16-positive participants: 31.3% hHSIL in clinics A-D versus 5.1% in clinics 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.