RISK-FACTORS FOR ANAL HUMAN PAPILLOMAVIRUS INFECTION AND ANAL CYTOLOGIC ABNORMALITIES IN HIV-POSITIVE AND HIV-NEGATIVE HOMOSEXUAL MEN

Men with advanced human immunodeficiency virus (HIV) disease have a hi gh prevalence of anal human papillomavirus (HPV) infection and potenti ally precancerous anal disease. To characterize prevalence of and risk factors for anal HPV infection and anal cytologic abnormalities, 37 H IV-positive and 28 HIV-negative participants in the San Francisco Gene ral Hospital Cohort Study were studied. A questionnaire was administer ed, followed by an anal examination consisting of two consecutive anal swabs for cytology and HPV DNA hybridization, and anoscopy with biops y of visible lesions. Ten of 28 (36%) HIV-negative men and 19 of 37 (5 1%) HIV-positive men had anal HPV infection (p = 0.32). Risk factors f or anal HPV infection included HIV positivity with a CD4 count <200/mm (3) (p = 0.03) and a history of smoking (p = 0.03). Abnormal anal cyto logy was found in 2 of 26 (8%) HIV-negative men and 10 of 36 (28%) HIV -positive men with cytology adequate for interpretation (p = 0.09). Ri sk factors for abnormal anal cytology included HIV positivity with a C D4 count <200/mm(3) (p = 0.006) and current smoking (p = 0.03). We con clude that the risk of development of anal disease and HPV infection w as highest among HIV-positive men with a CD4 count of <200/mm(3), and that smoking may play a role in the pathogenesis of anal disease.