1391. Prevalence of high-grade anal intraepithelial neoplasia increases further in early HIV infection
Session: Oral Abstract Session: Complications of HIV
Sunday, October 23, 2011: 7:30 AM
Room: 151AB
Background:  The incidence of anal cancer among HIV-infected men who have sex with men (MSM) is >10 times that of cervical cancer in U.S. women.  Anal intraepithelial neoplasia (AIN) comprises low-grade and high-grade (HGAIN) lesions − the most direct anal cancer precursor.  There are few studies that report the epidemiology of AIN in early HIV disease when disease may be more may be more readily treated compared to AIDS patients.

Methods:  We conducted a cross-sectional study of the prevalence and determinants of AIN in 82 MSM with early HIV infection (duration of HIV infection <365 days).  We used the detuned HIV assay and other methods to determine early HIV infection.  We obtained information on sexual behavior and drug use.  We obtained anal swabs for cytology, followed by biopsies of visible anal lesions using high resolution anoscopy.  We measured CD4+ T-cells.  Participants were categorized according to the highest grade of lesion measured by cytology or histology. We used logistic regression to determine factors associated with AIN.

Results:  The prevalence of AIN in early HIV infected participants was greater in participants whose duration of HIV infection was >6 months compared to participants whose duration of infection was ≤6 months (84% v 66%, P= 0.09).  The prevalence of HGAIN in early HIV infected participants whose duration of HIV infection was >6 months was significantly higher compared to those whose duration of infection was ≤6 months (52% v 22%, P <0.01).  Duration of HIV infection >6 months was an independent risk factor for HGAIN (OR= 5.91, 95% CI= 1.47 to 23.8, P= 0.01).  We found no evidence of association between AIN and CD4+ count (P>0.20).

Conclusion:  HGAIN, the precursor to anal cancer, likely develops in the later part of early HIV infection. In early HIV infection, CD4+ count is not helpful in assessing risk for HGAIN.  The development of HGAIN is a dynamic process even in early HIV infection.  Intervention with early treatment and possibly vaccination may be able to prevent the future development of anal cancer in this high-risk population.


Subject Category: H. HIV/AIDS and other retroviruses

John Lough, BS1, Joel Palefsky, MD2, J Michael Berry, MD3, Naomi Jay, PhD3, Mary Rubin, PhD3, Fred Fishman, BS3, Lauren Poole, NP3, Frederick Hecht, MD3 and Peter Chin-Hong, MD4, (1)Rush University Medical Center, Chicago, IL, (2)University of California, San Francisco, CA, (3)University of California at San Francisco, San Francisco, CA, (4)Internal Medicine, Division of Infectious Disease, UCSF, San Francisco, CA

Disclosures:

J. Lough, None

J. Palefsky, None

J. M. Berry, None

N. Jay, None

M. Rubin, None

F. Fishman, None

L. Poole, None

F. Hecht, None

P. Chin-Hong, None

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