Anal carcinoma is a common malignancy in HIV positive men with an incidence 80 times higher than the general population. It is preceded by Anal Squamous Intraepithelial Lesions (ASIL) and has anal human papillomavirus (HPV) as a major risk factor. An effective screening program for these conditions would allow treatment before invasive disease is established and may reduce the incidence of anal carcinoma in these men. Previous studies have shown the viability and cost- effectiveness of screening certain groups of HIV positive men. The populations examined in these studies have been mainly white men who have sex with men. At Columbia-Presbyterian Medical Center (CPMC), our HIV clinic is comprised of a diverse population including 50% Hispanics, 40% African-Americans and half who do not report having sex with men as a risk factor for HIV. The prevalence of ASIL and anal HPV infection in these groups of men is unknown. The study proposed here will help determine this information and suggest which of these men may benefit from screening for anal carcinoma. 200 HIV positive men from the Infectious Diseases clinic at CPMC will be enrolled. They will be examined with anal cytology, anal cytobrush in a liquid medium, HPV DNA PCR, and high resolution anoscopy with biopsy. A detailed sexual and behavioral questionnaire will be administered and immunologic parameters obtained from the clinic chart. This information will then be correlated to the presence of ASIL and HPV infection to elucidate the risk factors for these premalignant conditions. This pilot study will form the basis for subsequent multi-center trials to determine the sensitivity, specificity, positive and negative predictive values of these tests in an effort to bring this screening into the standard clinical care of HIV positive men.
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