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Effect of Highly Active Antiretroviral Therapy on the Natural History of Anal
Squamous Intraepithelial Lesions and Anal Human Papilloma virus Infection
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Joel M. Palefsky*; Elizabeth A. Holly; Mary L. Ralston; Maria Da Costa;
Helena Bonner; Naomi Jay; J. Michael Berry; Teresa M. Darragh
Departments of *Laboratory Medicine, Stomatology, Epidemiology and
Biostatistics, and Pathology, University of California, San Francisco, San
Francisco, California, U.S.A.
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES 2001;28:422-428
The effect of highly active antiretroviral therapy (HAART) on the natural
history of anal squamous intraepithelial lesions (ASIL)-the likely anal
cancer precursor-and anal human papillomavirus (HPV) infection is unknown.
ASIL severity and level of anal HPV DNA were evaluated among HIV-positive men
who have sex with men (MSM) for at least 6 months before initiation of HAART.
The results were compared with those from a 6-month period after
initiation of HAART. Anal swabs for cytology and HPV studies were obtained,
followed by high-resolution anoscopy and biopsy. Among men whose most severe
pre-HAART diagnosis was atypical squamous cells of undetermined significance
or low-grade ASIL, 18% (confidence interval [CI], 6-31%, 7 of 38) progressed
and 21% (CI, 8-34%, 8 of 38) regressed 6 months after starting HAART.
Seventeen percent (CI, 0-38%, 2 of 12) of study subjects who began with a
normal diagnosis developed ASIL. Only 4% (CI, 0-10%, 1 of 28) of study
subjects with high-grade ASIL
regressed to normal.
There was no reduction in the proportion of study
subjects who tested positive for HPV DNA or HPV DNA levels after HAART
initiation. The ASIL and HPV data were similar to those of the pre-HAART
comparison period. These results indicate that HAART has little effect on
either ASIL or HPV in the first 6 months after HAART initiation.
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