Anal condyloma prevalence among HIV infected patient

Background. - In the general HIV-infected Population, there are few data on the prevalence and risk factors for anal condyloma, precursor lesions for anal cancer. Methods. - Screening for perianal and endoanal condyloma with an anoscopy was systematically proposed to 516 consecutive outpatients, followed in a university hospital in Paris. For each point, HIV characteristics and sexual behaviors assessed through semi-directive questionnaire were collected. Findings. - The 473 (92%) examined patients, consisted of 200 homosexual men, 123 heterosexual men, 150 women; 76% were receiving HAART, HIV-RNA was < 50 copies/ml in 60%, mean (+/- SD) CD4 cell count were 484 (+/- 274)/mm(3). Overall, 108 (23%) pts had histologically-confirmed anal condyloma (36, 15 and 11% of the respective populations), including 51 (47%) pts with only endoanal localisation. Intraepithelial neoplasia of grade I was noted in 59 patients, of grade II in 10 and of grade III in 2 and an invasive endoanal cancer in 1. In multivariate regression analysis, condyloma independent risk factor were history of gonococcia or syphilis (OR = 0.54 (0.29-0.99)), and history of previous anal condyloma (OR = 2.05 (1.07-3.92) in homosexual men, history of previous penis condyloma (OR = 26.8 (2.3-309.6), and unprotected sexual intercourses (OR = 7.5 (2.1-26.3)) in heterosexual men and CD4 cell count below 200/mm(3), (OR = 8.9 (1.5-51.6)), receptive anal intercourses (OR = 6.7 (1.7-25.8)) and history of previous anal condyloma (OR = 25.4 (3.4-188.2)) in women. Interpretation. - In the HAART era, systematic screening revealed a high rate of anal condyloma in all HIV positive pts (not only in homosexual men). Anal examination should be proposed systematically to all HIV-infected patients. (c) 2005 Elsevier SAS. Tous droits reserves.