ANAL HUMAN PAPILLOMAVIRUS INFECTION AMONG HOMOSEXUAL AND BISEXUAL MEN- PREVALENCE OF TYPE-SPECIFIC INFECTION AND ASSOCIATION WITH HUMAN-IMMUNODEFICIENCY-VIRUS

Background and Objective: ''High-risk'' types of genital human papillo mavirus (HPV) infections are associated with anogenital cancer. As the se cancers occur more frequently in immunosuppressed individuals, we s ought to better characterize type-specific prevalence, clinical. spect rum, and risk factors for anal HPV infection among homosexual men. Stu dy Design: Cross-sectional and follow-up study of 93 HIV-seropositive (HIV+) and 116 HIV-seronegative (HIV-) homesexual/bisexual men, with t esting of anal swabs for HPV DNA by Virapap/Viratype assay. Results: O verall, 57 (61%) HIV+ and 20 (17%) HIV- men had anal HPV detected (P < .0001). HPV types 16/18 were most common, accounting far more than 50 % of infections. Among HIV+ men, HPV prevalence increased with declini ng CD4 cell count: 33% with counts of more than 750, 56% with counts o f 200 to 750, and 86% with counts less than 200 (P =.01). HPV infectio n was also associated with younger age and increasing numbers of lifet ime sexual partners for all men. Most infections were subclinical, wit h clinically apparent infection (anal warts) accounting for 35% of inf ections in HIV- men, 33% in asymptomatic HIV+ men, and 52% in men with AIDS/ARC. For both HIV- and HIV+ men, rates of anal HPV detection (23 % and 60%) were greater than those for the perianal area (5% and 37%) or penile shaft (2% and 7%) (P < .001). Persistence of anal HPV for 6 months was more common among men with AIDS/ARC (95%) than among asympt omatic HIV+ men (62%) or HIV- men (61%) (P < .05). Conclusions: Anal H PV infections are common in homosexual/bisexual men and have a strong relationship to HIV-associated immunosuppression. Because most infecti ons involve ''high-risk'' types of HPV, studies of their natural histo ry are needed to clarify the risk of anal neoplasia in men with HIV in fection.