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High Prevalence of Anal Human Papillomavirus Infection and Anal Cancer Precursors among HIV-Infected Persons in the Absence of Anal Intercourse

Christophe Piketty, MD; Teresa M. Darragh, MD; Maria Da Costa, MSc; Patrick Bruneval, MD; Isabelle Heard, MD; Michel D. Kazatchkine, MD, PhD; and Joel M. Palefsky, MD
[+] Article and Author Information

From INSERM U 430 and Hôpital Européen Georges Pompidou, Paris, France; and University of California, San Francisco, San Francisco, California.


Acknowledgments: The authors thank Drs. Laurence Weiss, Gustavo Gonzalez-Canali, Dominique Batisse, Marina Karmochkine, Martin Buisson, and Didier Jayle for their help in enrolling patients in the study; Helena Bonner and Daniel Felmlee for their technical assistance; and Gilles Chatellier for his help in statistical analysis.

Grant Support: SIDACTION-ENSEMBLE CONTRE LE SIDA provided funding to design the study, collect the data, and send the samples from Paris to San Francisco; to perform the histologic, cytologic, and HPV PCR analyses; and to perform the statistical analysis. Cytyc Corp., France, provided vials of PreservCyt fixative fluid and TransCyt filters used in the study. The National Center for Research Resources, National Institutes of Health, U.S. Public Health Service (5 M01-RR-00079), provided additional funding for performing HPV PCR.

Requests for Single Reprints: Christophe Piketty, MD, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75015 Paris, France; e-mail, Christophe.piketty@egp.ap-hop-paris.fr.

Potential Financial Conflicts of Interest:Consultancies: T.M. Darragh (Cytyc Corp.); Honoraria: T.M. Darragh (Cytyc Corp.); Grants received: T.M. Darragh (Cytyc Corp.), J. Palefsky (Cytyc Corp.); Other: T.M. Darragh (Speaker's Bureau for Cytyc Corp.).

Current Author Addresses: Drs. Piketty, Heard, and Kazatchkine: Department of Immunology, INSERM U 430 and Université Pierre et Marie Curie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.

Dr. Bruneval: Department of Pathology, INSERM U 430 and Université Pierre et Marie Curie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.

Dr. Palefsky and Ms. Da Costa: Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143.

Dr. Darragh: Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143.

Author Contributions: Conception and design: C. Piketty, I. Heard, J.M. Palefsky.

Analysis and interpretation of the data: C. Piketty, T.M. Darragh, M. Da Costa, P. Bruneval, I. Heard, M.D. Kazatchkine, J.M. Palefsky.

Drafting of the article: C. Piketty, I. Heard, M.D. Kazatchkine, J.M. Palefsky.

Critical revision of the article for important intellectual content: C. Piketty, T.M. Darragh, M. Da Costa, P. Bruneval, I. Heard, M.D. Kazatchkine, J.M. Palefsky.

Final approval of the article: C. Piketty, T.M. Darragh, M. Da Costa, P. Bruneval, I. Heard, M.D. Kazatchkine, J.M. Palefsky.

Provision of study materials or patients: C. Piketty, M.D. Kazatchkine.

Statistical expertise: C. Piketty.

Obtaining of funding: C. Piketty, M.D. Kazatchkine, J.M. Palefsky.

Administrative, technical, or logistic support: C. Piketty, T.M. Darragh, M. Da Costa, P. Bruneval, I. Heard, M.D. Kazatchkine, J.M. Palefsky.

Collection and assembly of data: C. Piketty, T.M. Darragh, M. Da Costa, P. Bruneval, I. Heard, M.D. Kazatchkine, J.M. Palefsky.


Ann Intern Med. 2003;138(6):453-459. doi:10.7326/0003-4819-138-6-200303180-00008
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We studied men with CD4+ cell counts less than 500 × 106 cells/L who acquired HIV through injection drug use and who reported no history of receptive anal intercourse. Our results demonstrate a high prevalence of abnormal anal histologic or cytologic findings and anal HPV infection in this group. Among HIV-infected injection drug users, 36% had histologic or cytologic abnormalities. Half of these abnormalities were HSIL, and the overall prevalence of HSIL was similar among HIV-positive injection drug users and men who had sex with men. Risk factors for abnormal anal histologic or cytologic findings in the injection drug users included immunosuppression, high plasma HIV RNA level, and anal HPV infection. Although our study did not include HIV-negative injection drug users, these data indicate that immunosuppression plays an important role in detecting anal HPV infection and anal histologic or cytologic abnormalities in HIV-positive men in the absence of anal intercourse.

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Summary for Patients

Anal Cancer Precursors in Persons with HIV Infection

The summary below is from the full report titled “High Prevalence of Anal Human Papillomavirus Infection and Anal Cancer Precursors among HIV-Infected Persons in the Absence of Anal Intercourse.” It is in the 18 March 2003 issue of Annals of Internal Medicine (volume 138, pages 453-459). The authors are C Piketty, TM Darragh, M Da Costa, P Bruneval, I Heard, MD Kazatchkine, and JM Palefsky.

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