Human papillomavirus-associated anal squamous intraepithelial lesions in men who have sex with men and transgender women living with and without HIV in Karachi Pakistan: implications for screening and prevention

Abstract Background Anal squamous intraepithelial lesions (ASIL), strongly related to human papilloma virus (HPV) infection, is more prevalent among men who have sex with men (MSM). However, no such data are available for Pakistan yet, and neither HPV vaccination nor anal-cytology screening is implemented in Pakistan. The purpose of this first ever study was to assess the prevalence of HPV-related anal cytological abnormalities among MSM and transgender women living with and without HIV infection in Pakistan. Methods We conducted a cross-sectional study from March 2016 to November 2017 at sexual health centers run by the Perwaaz Trust and the National AIDS Control Program in Karachi. The study enrolled MSM and transgender women aged greater-than-and-equal-to-18-years who reported anal sex in the preceding 6 months. We collected two anal samples for liquid-based cytology and HPV type testing by PCR, and socio-demographic and behavioral data were collected through face-to face interviews. ASIL and its associations with biological and behavioral risk factors were analyzed through Cox regression for prevalence ratios (PR) and corresponding 95% confidence intervals (CIs). Results Out of 271 qualifying participants, 79% were MSM and 21% transgender women. The mean age was 28.8 (± 8) years. Almost 35% (93/271) of the study population had ASIL detected, ASIL was significantly more common among participants living with HIV than in HIV negative ((50/118) 42.4%; vs. (43/153) 28.1%) (p ≤ 0.001). Among ASIL, 66% (61/93) had low-grade squamous intraepithelial lesions (LSIL), and 3.6% (3/93) had high-grade squamous intraepithelial lesions (HSIL). The overall, HPV16 positivity was 35.5% (33/93) among all abnormal anal lesions and all 3 HSIL were HPV16 positive, however, HPV16 positivity could show its association with ASIL detection in univariate model only (PRcrude: 2.11(1.39–3.18)). Moreover, any HR-HPV type (PR 3.04; 95% CI 1.75–5.26), concurrent sexually transmitted infection (STI) (2.13; (1.28–3.55)) and HIV + /HPV + coinfection (1.75; (1.07–2.88)) remained independently associated with ASIL in the multivariate model. Conclusions Abnormal anal cytology among MSM and transgender is prevalent enough to consider optimal screening regimens. Further studies are required to see if periodic anal cytology can be made part of HIV care and treatment programs among MSM in Pakistan.

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Anal Squamous Intraepithelial Lesions (SILs) in Human Immunodeficiency Virus–Positive Men Who Have Sex With Men: Incidence and Risk Factors of SIL and of Progression and Clearance of Low-Grade SILs

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz614 ◽

2019 ◽

Vol 222 (1) ◽

pp. 62-73 ◽

Cited By ~ 2

Author(s):

V W Jongen ◽

O Richel ◽

E Marra ◽

M L Siegenbeek van Heukelom ◽

A van Eeden ◽

...

Keyword(s):

Risk Factors ◽

Human Immunodeficiency Virus ◽

Hiv Positive ◽

Low Grade ◽

Squamous Intraepithelial Lesions ◽

Immunodeficiency Virus ◽

Anal Squamous Intraepithelial Lesions ◽

Sex With Men ◽

Intraepithelial Lesions

Abstract Background Human immunodeficiency virus (HIV)–positive men who have sex with men (MSM) are at risk of anal squamous cell carcinoma. Data are limited on the natural history of the precursor to this carcinoma, anal squamous intraepithelial lesions (SILs). Methods HIV-positive MSM were screened for histopathological SILs by means of high-resolution anoscopy (HRA). For participants without SILs at baseline, we estimated the cumulative incidence and risk factors for SILs. For those with low-grade SILs (LSILs) at baseline, the risk of progression to high-grade SILs (HSILs) and the clearance rate were estimated at the lesion level. Results Of 807 men without SILs at baseline, 107 underwent follow-up HRA between 1 to 4.5 years later. At the second visit 18 men (16.8%) showed LSIL, and 25 (23.4%) HSIL. Age was associated with incident LSILs (adjusted odds ratio [aOR], 2.10 per 10-year increase in age; P = .01). Of 393 men with LSILs at baseline, 114 underwent follow-up HRA 0.5 to 2.5 years later. Of the 177 LSILs found at baseline, 87 (49.2%) had cleared at the second visit, and 29 (16.4%) had progressed to HSILs. Conclusion Incident LSILs and HSILs were common during follow-up among HIV-positive MSM without dysplasia at baseline. Among men with LSILs at baseline, nearly half of these lesions cleared, and a small portion progressed.

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Multiple types of human papillomavirus infection and anal precancerous lesions in HIV-infected men in Taiwan: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2017-019894 ◽

2018 ◽

Vol 8 (1) ◽

pp. e019894 ◽

Cited By ~ 6

Author(s):

Shu-Hsing Cheng ◽

Kuo-Sheng Liao ◽

Chi-Chao Wang ◽

Chien-Yu Cheng ◽

Fang-Yeh Chu

Keyword(s):

Human Papillomavirus ◽

Cross Sectional Study ◽

Low Grade ◽

Sectional Study ◽

Squamous Intraepithelial Lesions ◽

Cross Sectional ◽

Anal Cytology ◽

Hpv Types ◽

The Relationship ◽

Intraepithelial Lesions

ObjectivesThis study aimed to assess the relationship between infection with multiple human papillomavirus (HPV) types and abnormal anal cytology in HIV-infected men.DesignAn observational, cross-sectional study.SettingA regional referral hospital in Taiwan.ParticipantsIn total, 714 HIV-infected men were enrolled between March 2011 and June 2016. Thin preparation anal Pap smears were interpreted according to the 2001 Bethesda System. Thirty-seven types of HPV were detected by reverse line blotting, including 13 oncogenic types and 24 non-oncogenic types.Outcome measuresThe relationship between anal HPV infection and abnormal anal cytology in people of Asian ethnicity and the coverage efficacy in HPV-vaccinated HIV-infected men.ResultsOn anal cytology, 175 (24.5%) subjects had atypical squamous cells of undetermined significance (ASCUS) or higher grades of dysplasia, including 87 (49.7%) with ASCUS, 73 (41.7%) with low-grade squamous intraepithelial lesions (LSILs) and 15 (8.6%) with high-grade squamous intraepithelial lesions (HSILs). A higher proportion of subjects with those without LSIL/HSIL (93.1% vs 67.3%, P<0.0001) had multiple HPV types. The odds of having LSIL/HSIL increased with an increasing number of HPV types: the ORs ranged from 1 for no HPV types to 6.96 (95% CI 2.38 to 20.37) for more than five types (Ptrend<0.0001). Multivariate logistic regression analysis showed a significant association between LSIL/HSIL and the number of HPV genotypes present (OR 1.20; 95% CI 1.02 to 1.42, P<0.05). HPV types covered by the nonavalent HPV vaccine (types 6/11/16/18/31/33/45/52/58) were detected in 70.1% of the patients in this study.ConclusionsThe odds of having anal LSIL/HSIL are approximately seventimes greater in HIV-infected men with than withoutsix or more types of HPV. Multiple HPV types in HIV-infected patients deserves aggressive follow-up, and HPV vaccination programme require scaling up.

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Prevalence of anal squamous intraepithelial lesions in HIV-positive and HIV-negative men who have sex with men in Thailand.

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.15_suppl.1598 ◽

2010 ◽

Vol 28 (15_suppl) ◽

pp. 1598-1598

Author(s):

T. Chalermchai ◽

A. H. Li ◽

J. Ananworanich ◽

N. Teeratakulpisarn ◽

W. Sathainthammawit ◽

...

Keyword(s):

Hiv Positive ◽

Squamous Intraepithelial Lesions ◽

Anal Squamous Intraepithelial Lesions ◽

Sex With Men ◽

Intraepithelial Lesions ◽

Hiv Negative

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Cytological Anal Squamous Intraepithelial Lesions Associated with Anal High-Risk Human Papillomavirus Infections among Men Who Have Sex with Men in Northern Thailand

PLoS ONE ◽

10.1371/journal.pone.0156280 ◽

2016 ◽

Vol 11 (5) ◽

pp. e0156280 ◽

Cited By ~ 13

Author(s):

Darin Ruanpeng ◽

Suwat Chariyalertsak ◽

Quanhathai Kaewpoowat ◽

Taweewat Supindham ◽

Jongkolnee Settakorn ◽

...

Keyword(s):

Human Papillomavirus ◽

High Risk ◽

Papillomavirus Infections ◽

Squamous Intraepithelial Lesions ◽

Northern Thailand ◽

Anal Squamous Intraepithelial Lesions ◽

Sex With Men ◽

Intraepithelial Lesions

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Electrocautery Ablation of High-Grade Anal Squamous Intraepithelial Lesions in HIV-Negative and HIV-Positive Men Who Have Sex With Men

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e3182437469 ◽

2012 ◽

Vol 59 (3) ◽

pp. 259-265 ◽

Cited By ~ 51

Author(s):

Douglas K. Marks ◽

Stephen E. Goldstone

Keyword(s):

Hiv Positive ◽

High Grade ◽

Squamous Intraepithelial Lesions ◽

Anal Squamous Intraepithelial Lesions ◽

Sex With Men ◽

Intraepithelial Lesions ◽

Hiv Negative ◽

Hiv Positive Men

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Anal squamous intraepithelial lesions among HIV positive and HIV negative men who have sex with men in Thailand

Sexually Transmitted Infections ◽

10.1136/sti.2009.036707 ◽

2009 ◽

Vol 85 (7) ◽

pp. 503-507 ◽

Cited By ~ 14

Author(s):

A H Li ◽

N Phanuphak ◽

V V Sahasrabuddhe ◽

S Chaithongwongwatthana ◽

S H Vermund ◽

...

Keyword(s):

Hiv Positive ◽

Squamous Intraepithelial Lesions ◽

Anal Squamous Intraepithelial Lesions ◽

Sex With Men ◽

Intraepithelial Lesions ◽

Hiv Negative

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Implementation of and Early Outcomes From Anal Cancer Screening at a Community-Engaged Health Care Facility Providing Care to Nigerian Men Who Have Sex With Men

Journal of Global Oncology ◽

10.1200/jgo.19.00102 ◽

2019 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Rebecca G. Nowak ◽

Nicaise Ndembi ◽

Wuese Dauda ◽

Paul Jibrin ◽

Søren M. Bentzen ◽

...

Keyword(s):

Anal Cancer ◽

Care Facility ◽

Health Care Facility ◽

Low Grade ◽

Squamous Intraepithelial Lesions ◽

First Line ◽

Prevalence Estimates ◽

Sex With Men ◽

Anal Cancer Screening ◽

Intraepithelial Lesions

PURPOSE Anal cancer risk is substantially higher among HIV-infected men who have sex with men (MSM) as compared with other reproductive-age adults, but screening is rare across sub-Saharan Africa. We report the use of high-resolution anoscopy (HRA) as a first-line screening tool and the resulting early outcomes among MSM in Abuja, Nigeria. METHODS From August 2016 to August 2017, 424 MSM enrolled in an anal cancer screening substudy of TRUST/RV368, a combined HIV prevention and treatment cohort. HRA-directed biopsies were diagnosed by histology, and ablative treatment was offered for high-grade squamous intraepithelial lesions (HSIL). HRA proficiency was assessed by evaluating the detection of squamous intraepithelial lesions (SIL) over time and the proportion biopsied. Prevalence estimates of low-grade squamous intraepithelial lesions and HSIL with 95% CIs were calculated. Multinomial logistic regression was used to identify those at the highest risk of SIL. RESULTS Median age was 25 years (interquartile range [IQR], 22-29), median time since sexual debut was 8 years (IQR, 4-12), and 59% (95% CI, 54.2% to 63.6%) were HIV infected. Rate of detection of any SIL stabilized after 200 screenings, and less than 20% had two or more biopsies. Preliminary prevalence estimates of low-grade squamous intraepithelial lesions and HSIL were 50.0% (95% CI, 44.7% to 55.3%) and 6.3% (95% CI, 4.0% to 9.3%). HIV infection, at least 8 years since anal coital debut, concurrency, and external warts were independently statistically associated with SIL. CONCLUSION Proficiency with HRA increased with experience over time. However, HSIL detection rates were low, potentially affected by obstructed views from internal warts and low biopsy rates, highlighting the need for ongoing evaluation and mentoring to validate this finding. HRA is a feasible first-line screening tool at an MSM-friendly health care facility. Years since anal coital debut and external warts could prioritize screening.

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