1502. Risk Factors for the Development of Anal Dysplasia in Patients Co-Infected with Human Immunodeficiency Virus and Human Papillomavirus
Session: Poster Abstract Session: HIV and Co-infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Human papillomavirus (HPV) causes dysplastic changes in squamocolumnar junctions.  Co-infection with human immunodeficiency virus (HIV) accelerates the effects of HPV.  The overall incidence of anal squamous cell carcinoma has been steadily increasing over the past 10 years.  The purpose of this study is to develop a list of risk factors of the HIV infected population to assist clinicians in screening for anal dysplasia in an era of limited healthcare resources.

Methods: A retrospective review of 177 charts from the Center for HPV and Dysplasia at the Regional Medical Center at Memphis was conducted.  All records reviewed were selected based on co-infection with HIV and HPV infection with a previous anal pap smear.  Individuals excluded from the review were those without a history of HIV and HPV infection or incomplete records.  Forty-nine data points were collected from each record, the aggregate data was anonymized, and statistical analysis was performed.  Categorical variables (ie. history of smoking) were analyzed with an uncorrected chi square.  Continuous variables (ie. CD4 count and HIV viral load) were analyzed with a t-test.  A p-value of ≤ 0.05 was considered to be statistically significant.

Results: Inclusion criteria required elimination of 77 records, 61 records lacked HIV infection, and 16 records had incomplete data for statistical analysis. Statistically significant factors included duration of HIV infection >5 years (P= 0.007), CD4 T-lymphocyte count <370 (P= 0.005), uncontrolled serum HIV viral load (P= <0.001), absence or poor compliance with highly active anti-retroviral therapy (HAART) (P= <0.001), and history of multiple sexual partners (P= <0.001).

Conclusion: In this study, five risk factors met statistical significance and six risk factors failed to meet statistical significance.  Risk factors including duration of HIV infection >5 years, a CD4 T-lymphocyte count <370, uncontrolled HIV viral load, absence or poor compliance with HAART, and a history of multiple sexual partners are major risk factors for developing anal dysplasia.  Patients with at least one of the major risk factors should be screened at least yearly with anal pap smears.  Additional studies involving more patients may be helpful in further defining the clinical importance of these risk factors.

William Todd, DO1, Wendy Likes, PhD, DNSc2, Lynda Gioia-Flynt, MD2 and Susan Brewer, MD1, (1)Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, (2)Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN


W. Todd, None

W. Likes, None

L. Gioia-Flynt, None

S. Brewer, None

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