Prevalence of high-grade dysplasia and cancer in the anal canal in human papillomavirus-infected individuals

Background & Aims: The incidence of anal cancer is higher in patients with anal canal condyloma, a sexually transmitted disease, than in the general p opulation. We determined the prevalence of anal dysplasia and cancer in pat ients with anal canal condyloma with respect to human immunodeficiency viru s (HIV) status, immunity status, and human papillomavirus types, Methods: I n 174 consecutive patients (114 HIV positive, 60 HIV negative) with anal ca nal condyloma, lesions were cured, and the patients were then followed up p rospectively. Langerhans cells (LCs) in normal anal mucosa were quantified, and viruses (Epstein-Barr virus, cytomegalo-virus, human simplex virus 1, and various human papillomavirus [HPV] types) were characterized on inclusi on. During follow-up (median 26 months), relapsed condylomas were resected and examined histologically. HIV load and CD4 T-lymphocyte counts in serum were determined at each visit, Results: Several factors differed significan tly between HIV-positive and HIV-negative patients: LCs/mm anal tissue (15 vs. 30), oncogenic HPV (27% vs, 13%), other current anal infections (44% vs . 0%), and sex ratio (93% vs. 73% male). During follow-up, condylomas relap sed in 75% of the HIV-positive patients, with 19 high-grade dysplasias (HGD s) and 1 invasive carcinoma, but in only 6% of HIV-negative patients, with 1 HGD. Male sex, HIV positivity, and <15 LCs/mm tissue were independent ris k factors for condyloma relapse. HIV positivity, HGD before inclusion, and condyloma relapse were independent risk factors for HGD and cancer. Serum H IV load was associated with relapse, whereas CD4 T-lymphocyte counts were n ot, Conclusions: The prevalence of HGD and carcinoma is higher in HIV-posit ive than in HIV-negative patients, probably because of HPV activity, HIV-po sitive patients with high serum HIV load and/or a history of anal dysplasia should be examined by anoscopy, and condylomas should be analyzed histolog ically.