Story Summary: The men were stratified according to whether they were ARV-naive and, if not, whether they had taken regimens containing PIs, NNRTIs, or both. Of these 205, 57 (28%) had only taken PI-containing regimens, 13% only NNRTI-containing regimens, and 60% both. There were very high rates of HPV infection, with 89% of the treatment-naive men and 74% of those on ART infected. On the other hand, ever having taken a treatment interruption was associated with a 75% increase in the odds of having dysplasia, and treatment interruption was also associated with a 4. Dr Sirera, answering a question from the audience, said it was difficult to say why the anal dysplasia rates in this study were so high, though men at higher risk might be more motivated to volunteer for a cohort study. In this Dr Andrea de Luca and colleagues from the Gemelli Polyclinic in Rome enrolled 189 consecutively-diagnosed patients. Patients still had to consent to anal biopsies, but Dr de Luca commented that few patients refused consent to be enrolled. De Luca and colleagues performed similar infection and cytology tests but also did genetic activation tests to look for the expression of the HPV genes E6 and E7. When these are expressed they enhance the chances of cancer and are usually expressed at much higher rates in HPV 16 and 18, the two riskiest types and the ones covered by the Gardasiland Cervarixvaccines. As might be expected from a consecutive sample, this was a varied group with 14% having had no sexual partners in the last year and 13% over 20 partners; 53% had never had receptive anal sex while 19% had had it with over 100 partners. Although the predominant high-risk type was HPV 16, infection with three high-risk subtypes (31, 33 and 35) not covered by vaccines were found in around a quarter of patients each. In 90 (44%) of patients the HPV genetic activity could be measured and it was found that cancer genes were active in nearly three-quarters of patients with high-risk HPV. The genes expressed belonged to HPV 16 and 18, but also came from other subtypes: a third expressed cancer genes from HPV 45 and 20% from HPV 35. Infection did not appear to be related to the frequency of anal intercourse. The good news is that new infections with HPV were outnumbered by patients who became negative for infection, and progression of dysplasia was relatively uncommon. Seven patients developed new anal dysplasia but two who had had dysplasia were normal at follow-up. ReferencesSirera G et al. Highly active antiretroviral regimens on the prevalence of anal human papilloma virus infection and anal pathology in HIV-infected men. De Luca A et al. Frequent detection of multiple, oncogene-expressing high-risk HPV types in anal swabs from HIV-infected individuals: predictors and associations with anal dysplasia….Read the Full Story

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