The Natural History of Anal High-grade Squamous Intraepithelial Lesions in Gay and Bisexual Men

• Published in: Clinical infectious diseases 2021-03, Vol.72 (5), p.853-861
• Main Authors: Poynten, I Mary, Jin, Fengyi, Roberts, Jennifer M, Templeton, David J, Law, Carmella, Cornall, Alyssa M, Molano, Monica, Machalek, Dorothy A, Carr, Andrew, Farnsworth, Annabelle, Tabrizi, Sepehr, Phillips, Samuel, Fairley, Christopher K, Garland, Suzanne M, Hillman, Richard J, Grulich, Andrew E
• Format: Article
• Language: English
• Subjects: Aged; Anal Canal; Anus Neoplasms - diagnosis; Anus Neoplasms - epidemiology; Bisexuality; HIV Infections - complications; HIV Infections - epidemiology; Homosexuality, Male; Humans; Male; Middle Aged; Papillomaviridae - genetics; Papillomavirus Infections - complications; Papillomavirus Infections - epidemiology; Sexual and Gender Minorities; Squamous Intraepithelial Lesions
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciaa166

Abstract Background Gay and bisexual men (GBM) are disproportionately affected by anal cancer. Prevention is hindered by incomplete understanding of the natural history of its precursor, anal high-grade squamous intraepithelial lesions (HSIL). Methods The Study of the Prevention of Anal Cancer, conducted between 2010 and 2018, enrolled human immunodeficiency virus (HIV)-positive and HIV-negative GBM aged ≥35 years. Anal cytology and high-resolution anoscopy (HRA) were performed at baseline and 3 annual visits. A composite HSIL diagnosis (cytology ± histology cHSIL) was used. Cytological high-grade squamous intraepithelial lesions (cHSIL) incidence and clearance rates were calculated with 95% confidence intervals (CIs). Predictors were calculated using Cox regression with hazard ratios (HRs) and 95% CIs. Results Among 617 men, 220 (35.7%) were HIV-positive, median age 49 years. And 124 incident cHSIL cases occurred over 1097.3 person-years (PY) follow-up (11.3, 95% CI 9.5–13.5 per 100 PY). Significant bivariate predictors of higher incidence included age