Men who have sex with men (MSM) and transgender women (TW) with HIV are disproportionately affected by anogenital human papillomavirus (HPV) infection with high rates of anal intraepithelial neoplasia (AIN) and subsequent anal cancer. However, there are no national guidelines for anal cancer screening and vaccination rates among men and TW remain low. There is a need to understand risk factors for high-grade anal dysplasia to inform screening guidelines and preventative measures in these groups. In this study, we evaluated factors associated with high-grade anal dysplasia on anal biopsy among young MSM and TW with HIV in Atlanta, GA.
Retrospective chart review was conducted for all cisgender MSM and TW with HIV aged 13-25 at the Grady Ponce and Family Youth Clinic in Atlanta, GA from 2009-2020. Participants who underwent anal biopsy over the study period were included. Data were collected on patient characteristics, sexual history, and anal histology results, with high-grade anal dysplasia defined as AIN 2 or 3. Associations between clinical and demographic factors with high-grade anal dysplasia were estimated using logistic regression (SAS v9.4, Cary, NC). Adjusted odds ratios (aORs) and 90% confidence intervals (CIs) are reported. Statistical significance was assessed at the 0.10 alpha-level.
103 MSM and TW with HIV were included. The mean age was 19.7 (SD: ±1.9) years. 91% were Black and 98% were horizontally infected with HIV. 63% of participants had high-grade anal dysplasia on anal biopsy. Having ever received surgical treatment for anogenital HPV (aOR 2.59, 90%CI 1.18-5.66, p=0.05) and being incompletely or unvaccinated against HPV (0-2 doses) relative to being fully vaccinated (3 doses) (aOR 5.34, 90%CI 1.30-21.93, p=0.05) were strongly associated with high-grade anal dysplasia, controlling for age and CD4 T-cell count at time of biopsy.
Our study found disproportionately high rates of high-grade anal dysplasia on anal biopsy among young MSM and TW with HIV. Furthermore, those who had ever received surgical treatment for anogenital HPV and those who were incompletely or unvaccinated against HPV were more likely to have high-grade disease. To our knowledge, this is the first study to show an association between vaccination status and high-grade anal dysplasia in this population. Our data emphasize the urgent need to improve HPV vaccination efforts and to pursue larger surveillance studies of high-grade disease among young MSM and TW with HIV.