Virological and serological predictors of anal high-grade squamous intraepithelial lesions among HIV-positive men who have sex with men.

Background: Our objective was to identify virological and serological predictors of anal high-grade squamous intraepithelial lesions (HSIL) in HIV-positive men-who-have-sex-with-men (MSM).

Methods: HIV-positive MSM were recruited from a longitudinal study (2010-2013), during which anal self-swabs and serum were collected at up to five bi-annual visits. Swabs were HPV genotyped, and type-specific HPV viral load in anal swabs was determined. Serum antibodies to E6, E7, E1, E2 and L1 proteins of 7 hrHPV-types and HPV6 and 11 were analyzed. 193 participants had a high-resolution anoscopy (HRA) after the last study visit and were included in the current analysis. Anal HSIL was diagnosed by histopathological examination of anal biopsies. Causative HPV-type of anal HSIL was determined in whole tissue sections (WTS) and by laser capture micro-dissection if more than one HPV-type was found in WTS. Multivariable logistic regression was used to study whether persistent anal HPV infection, HPV viral load and seropositivity for HPV were predictors of anal HSIL, in general and caused by the concordant HPV type.

Results: Of 193 HIV-positive MSM, 50 (26%) were diagnosed with anal HSIL. HrHPV persistence in anal swabs was common, varying by hrHPV-type between 3-21%. Neither anal hrHPV viral load, nor seropositivity for L1, E6, E7, E1, or E2 was associated with anal HSIL. Only anal HPV persistence was independent associated with anal HSIL, in general and by concordant causative HPV-type.

Conclusion: Persistent HPV infection was strongly associated with anal HSIL, in general as well as for concordant HPV-type.