Prevalence and risk factors associated with high-grade anal squamous intraepithelial lesions (HSIL)-AIN2 and HSIL-AIN3 in homosexual men

Dorothy A. Machalek, Fengyi Jin, I. Mary Poynten, Richard J. Hillman, David J. Templeton, Carmella Law, Jennifer M. Roberts, Sepehr N. Tabrizi, Suzanne M. Garland, Annabelle Farnsworth, Christopher K. Fairley, Andrew E. Grulich, the SPANC study team

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Background: Anal intraepithelial neoplasia grade 2 (AIN2) and AIN grade 3 (AIN3) are commonly grouped together as high grade squamous intraepithelial lesions (HSIL). We assessed risk factors for HSIL-AIN2 and HSIL-AIN3 in a cohort of homosexual men.Methods: At the baseline visit in the Study for the Prevention of Anal Cancer (SPANC), all men completed a questionnaire and underwent anal swabbing for cytology and HPV genotyping, followed by high resolution anoscopy. Results: Composite-HSIL prevalence was 47% and 32% among 220 HIV-positive and 396 HIV-negative men, respectively. HSIL-AIN3 (37.7% versus 24.7%; p<0.001), but not HSIL-AIN2 (9.5% versus 7.6%; p=0.395) was more common in HIV-positive men. Recent receptive anal partners (p-trend=0.045), and increasing number of high-risk (HR)-HPV types (p-trend<0.001) were associated with HSIL-AIN2. Lifetime receptive partners (p-trend<0.001), HIV status (OR 1.74; 95% CI: 1.05–2.87) and HPV16 (OR 3.00; 95% CI: 1.56–5.75) were associated with HSIL-AIN3. HPV16 was the most common HR-HPV type detected in men with HSIL-AIN3, both HIV-negative (61.1%) and HIV-positive (54.9%). HPV16 was less commonly detected in men with HSIL-AIN2. Conclusions: Grouping HSIL-AIN2 and HSIL-AIN3 as HSIL may mask considerable heterogeneity in anal cancer risk. Given the strong link between HPV16 and anal cancer, men with HSIL-AIN3 and HPV16 are likely to be at greatest risk of cancer. Abbreviations: AIN, anal intraepithelial neoplasia; ASIL, anal squamous intraepithelial lesion; CIN, cervical intraepithelial neoplasia; HSIL, high grade squamous intraepithelial lesion;HRA, high resolution anoscopy; HIV, human immunodeficiency virus; HPV, human papillomavirus; MSM, men who have sex with men; SPANC, Study for the Prevention of Anal Cancer.
Original languageEnglish
Pages (from-to)97-105
Number of pages9
JournalPapillomavirus Research
Publication statusPublished - 1 Dec 2016


  • Cancer screening
  • HSIL
  • Human papillomavirus
  • Risk factors
  • Surrogate endpoints

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