Takeshi Nishijima1, Naoyoshi Nagata2, Kazuhiro Watanabe3, Katsunori Sekine3, Shohei Tanaka3, Yoshihiro Kishida3, Tomonori Aoki3, Yohei Hamada4, Hirohisa Yazaki4, Katsuji Teruya4, Hiroyuki Gatanaga1, Yoshimi Kikuchi4, Toru Igari5, Junichi Akiyama3, Masashi Mizokami6, Kazuma Fujimoto7, Naomi Uemura8, Shinichi Oka1. 1. AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan. 2. Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan. Electronic address: nnagata_ncgm@yahoo.co.jp. 3. Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan. 4. AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan. 5. Pathology Division of Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan. 6. The Research Center for Hepatitis and Immunology, Department of Gastroenterology and Hepatology. 7. Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan. 8. Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan.
Abstract
OBJECTIVE: To investigate the association between anorectal precancerous lesions, including condyloma, and sexually transmitted infections (STI) in Asian population. METHODS: This prospective study enrolled 2677 patients who underwent high-resolution colonoscopy for anorectal cancer screening. Anorectal lesions were diagnosed based on endoscopic findings and confirmed by biopsy. The association of HIV-1 infection, syphilis, and HBV infection with anorectal lesion was estimated by multivariate logistic regression. In HIV-1-infected patients (n=244), anal canal HPV-DNA was screened and genotyped. RESULTS: Although no malignancy was identified, anorectal condyloma was diagnosed in 32 (1.2%) male patients. 41% of anorectal condyloma cases had no specific lower GI symptoms. Multivariate analysis identified HIV-1 infection, but not syphilis or HBV infection, as an independent significant factor for condyloma (OR: 176.5, 95%CI 22.52-1383, p<0.001). In HIV-1 infected patients, positive type 16/18 HPV-DNA (OR: 4.766, 95%CI 1.838-12.36, p=0.001), lower CD4 cell count (per 100/μl decrement, OR: 1.056, 95%CI 1.056-1.587, p=0.013), and current smoking (OR: 3.828, 95%CI 1.486-9.857, p=0.005) were independently associated with anorectal condyloma. CONCLUSIONS: HIV-1 infection, but not syphilis or HBV infection, was identified as a strong risk for anorectal condyloma. Anal HPV 16/18 was highly prevalent in patients with HIV-1 infection, especially in those with condyloma.
OBJECTIVE: To investigate the association between anorectal precancerous lesions, including condyloma, and sexually transmitted infections (STI) in Asian population. METHODS: This prospective study enrolled 2677 patients who underwent high-resolution colonoscopy for anorectal cancer screening. Anorectal lesions were diagnosed based on endoscopic findings and confirmed by biopsy. The association of HIV-1 infection, syphilis, and HBV infection with anorectal lesion was estimated by multivariate logistic regression. In HIV-1-infectedpatients (n=244), anal canal HPV-DNA was screened and genotyped. RESULTS: Although no malignancy was identified, anorectal condyloma was diagnosed in 32 (1.2%) male patients. 41% of anorectal condyloma cases had no specific lower GI symptoms. Multivariate analysis identified HIV-1 infection, but not syphilis or HBV infection, as an independent significant factor for condyloma (OR: 176.5, 95%CI 22.52-1383, p<0.001). In HIV-1 infectedpatients, positive type 16/18 HPV-DNA (OR: 4.766, 95%CI 1.838-12.36, p=0.001), lower CD4 cell count (per 100/μl decrement, OR: 1.056, 95%CI 1.056-1.587, p=0.013), and current smoking (OR: 3.828, 95%CI 1.486-9.857, p=0.005) were independently associated with anorectal condyloma. CONCLUSIONS:HIV-1 infection, but not syphilis or HBV infection, was identified as a strong risk for anorectal condyloma. Anal HPV 16/18 was highly prevalent in patients with HIV-1 infection, especially in those with condyloma.