Prevalence and risk factors for anal dysplasia among men who have sex with men living with HIV: the HPV Screening and Vaccine Evaluation (HPV-SAVE) Study


BACKGROUND: HPV-associated anal cancer is a common malignancy in men who have sex with men living with HIV (MSMLWH). Despite recent indications that screening reduces the incidence of anal cancer, access is limited to urban centres and is coupled with substantial waitlists requiring the need for triaging care. We assessed the prevalence of and risk factors for anal dysplasia among MSMLWH.
METHODS: The HPV-SAVE study examines anal cancer screening in MSMLWH in Vancouver, Ottawa and Toronto, Canada. Between 01/2016 and 05/2021, participants were recruited from HIV clinics and completed a questionnaire pertaining to demographics and medical history. We screened participants for anal dysplasia via anal pap, defined as any non-normal result on cytology using the Bethesda classification. We completed descriptive statistics to report the prevalence of anal dysplasia and binomial logistic regression to identify risk factors for dysplasia.
RESULTS: Among 720 participants screened, most were white (70.0%), over 50 years-old (52.1%) and unpartnered (53.8%). Most had dysplasia (344/663; 51.9%): ASCUS (223/663; 33.6%), LSIL (77/663; 11.6%), HSIL (18/663; 2.7%); and ASC-H (16/663; 2.4%). Many participants reported past anogenital warts (269/699; 38.5%) however, this did not increase the odds of dysplasia (odds ratio [OR] 1.03 95% confidence interval [CI] 0.75, 1.41). Black participants were less likely to have dysplasia than non-Black participants (OR 0.47, 95% CI 0.23, 0.96), as were individuals who acquired HIV between 2000-2010 relative to those who were diagnosed after 2010 (OR 0.63 95% CI 0.42, 0.94). Elevated odds of dysplasia were observed for current smokers and individuals who quit within the past 5-years (OR 1.42; 95% CI 1.01, 2.01) and individuals with quarterly physician visitation compared to individuals with biannual visitation (OR 1.61, 95% CI 1.00, 1.93). There was no association between dysplasia and low self-reported CD4+ count (OR 1.10 95% CI 0.75, 1.62) or elevated age (OR 1.10 95% CI 0.80, 1.50).
CONCLUSIONS: Anal dysplasia is common among MSMLWH. Smoking, frequent physician visitation, recent HIV acquisition and non-Black ethnicity were associated with dysplasia. These interim results highlight the importance of further research addressing mediators and confounders of engagement in anal cancer screening to support treatment and care for MSMLWH.

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