Anal human papillomavirus DNA screening by hybrid capture II™ in human immunodeficiency virus-positive patients with or without anal intercourse

High risk human papillomaviruses (HPVs) have emerged as risk factors for anal carcinoma, of which incidence is higher in HIV-positive patients than in the general population. The aim of our study was to investigate the prevalence and risk factors for anal HPV infections in HIV-positive patients with or without history of anal intercourse. Fifty HIV1-infected patients (36 men and 14 women) were tested at entry and followed-up every 3 months for one year for the presence of anal HPV DNA by the Hybrid Capture II(TM) assay. A series of 50 HIV-negative subjects matched for age and sex served as controls. At enrolment, anal HPV DNA was present in 29/50 HIV-positive patients (58%) and in 3/50 control subjects (6%). High risk (HR) HPV genotypes were detected in 20/50 HIV-positive patients (40%) with no difference in homosexual men and other HIV-positive patients. Risk factors for HPV infection were CD4+ cell counts less than 500/muL (RR: 2.13 [95 % CI: 1.0-4.7]) and history of anogenital warts (RR: 2.36 [95 % CI: 1.2-4.6]). The HPV load was higher in patients with CD4+ less than or equal to 500/muL than in patients with CD4+ > 500/muL (p < 0.04). During the follow-up, anal HR HPV DNA was repeatedly identified at high levels in 5 HIV-positive patients. There is some convincing evidence that HIV-positive patients with low CD4+ cells, whatever the routes of HIV transmission, have a high rate of anal HPV infection and might be at increased risk of developing anal neoplastic lesions. Identifying HR HPV infection might be warranted in immunosuppressed patients.