Introduction: The incidence of human papillomavirus (HPV)-associated anal cancer is high in homosexual men, especially in the HIV-positive, but an understanding of the epidemiology of HSIL, the presumed precursor is lacking. We aimed to determine the prevalence and risk factors for HSIL in a community-recruited cohort of homosexual men.
Methods: The Study for the Prevention of Anal Cancer (SPANC) is a three-year study investigating the natural history of anal HPV infection and associated lesions in homosexual men aged ≥35 years. At each visit all men receive an anal swab for cytology and HPV genotyping (Roche Linear Array), and high resolution anoscopy with biopsy of suspected lesions. Using composite diagnosis, anal HSIL was defined as having either intraepithelial neoplasia grade 2/3 on histology and/or possible HSIL/HSIL on cytology.
Results: 342 men were recruited by the end of March 2013. Median age was 49 and 28.7% were HIVpositive. Overall 68.7% of men had HPV-related anal abnormalities. Just under half (45.6%) of the men (50.0% of the HIV-positive and 43.9% of the HIV-negative, p=0.053) had HSIL. HSIL-AIN2 and HSIL-AIN3 were diagnosed in 17.0% and 28.7% of men respectively. HIV-positive men were more likely to have HSIL-AIN3 (p=0.053) than HIV-negative men. The prevalence of HSIL was significantly higher in men with detectable HPV16 or HPV18 DNA compared to those without (71.8% versus 30.9%, p<0.001). In multivariate analysis, HSIL was associated with HPV16 (p<0.001), HPV18 (p=0.017), history of anal warts (p=0.006), higher level of education (p=0.041), and current cigarette smoking (p=0.035).
Conclusion: The prevalence of HSIL was very high in this population. The strong associations with HPV16 and HPV18 suggest that universal vaccination of adolescent boys has enormous potential to prevent HPV-related morbidity among men in the future. Research is needed to help identify, and effectively treat those at highest risk of progressing to cancer.
The case is of a 30 year-old HIV positive Zimbabwean woman (UK resident) who arrived in Australia in January 2011 on a one-year working visa. She was diagnosed with HIV in 2003 in the UK and commenced on Atripla® in 2005. She was first seen in Adelaide in May 2011, requesting a script for Atripla.®.
Background: Liquid based anal Papanicolaou smears, followed by High Resolution Anoscopy (HRA) guided biopsies are increasingly being advocated to identify areas of High Grade Anal Intraepithelial Neoplasia (HGAIN). We hypothesized that the ability to identify HGAIN would increase with experience of the anoscopist, and that comparison with contemporary Papanicolaou smears might yield insights into technical abilities.
Indigenous Australians experience a greater burden of sexually transmitted infections, however are less likely than the general population to access sexual health services. We examined the effectiveness of an Indigenous cultural appropriateness audit in assessing a sexual health clinic with low rates of Indigenous clients.
Despite the high proportion of young people annually accessing general practices, including Aboriginal Medical Services (AMS), testing for Chlamydia trachomatis remains relatively low in urban areas. A project officer was employed within the Institute of Urban Indigenous Health (IUIH) to serve a mentoring and facilitation role for the SE Queensland network of AMS and their sexual health workers, with a view to improving testing, management and follow-up of chlamydia and other STIs by community controlled medical services.
Monocytes are a heterogeneous cell population having specialised functions and differing phenotype. They are a link between innate immune system and adaptive immune system therefore, to identify if immune activation exists in HIV-1 individuals with controlled virema and recovered CD4 T cell counts, we assessed cell surface monocyte activation markers (MAM) within the monocyte subsets.
Involving consumers in healthcare decisions is important for high quality care. We previously tested a brief, consumer-led intervention consisting of three questions in a trial employing trained, standardized patients. The intervention enhanced discussion of evidence and increased patient involvement. We now report a research translation study which tested implementation with real patients at a reproductive and sexual health clinic.