HIV-Positive Hijra Sex Workers with high prevalence of Anal Intraepithelial Lesions: A cross sectional study from Karachi Pakistan

Background: Anal cancer is caused by Human Papilloma Virus which is detected in approximately 90% of squamous cell anal cancers and its high grade squamous intraepithelial lesions (HSIL). Anal cancer among men having sex with... [ view full abstract ]

Background: Anal cancer is caused by Human Papilloma Virus which is detected in approximately 90% of squamous cell anal cancers and its high grade squamous intraepithelial lesions (HSIL). Anal cancer among men having sex with men (MSM) exceeds that of cervical cancer in women, and HIV-positive homosexual men may be at even higher risk than HIV-negative men. HSIL is the precursor to anal cancer likewise cervical cancer which is also preceded by HSIL cancer. Receptive anal intercourse is thought to be a risk factor for HPV in MSM.

Objective: To evaluate the prevalence of HSIL and Human Papilloma Virus infection among HIV positive Hijra Sex workers who by definition are MSM.

Study Design: a cross sectional study of HIV-positive MSM was conducted.
Study Setting: Service Delivery Points offered by Sindh AIDS Control & Prevention Program.
177 HIV-positive MSM were enrolled. A questionnaire was administered detailing lifestyle habits, medical history and sexual practices. Anal swabs for cytology were obtained, followed by biopsies of visible lesions. Blood was obtained for HIV testing and measurement of CD4 levels.

Main outcome measures: Prevalent HSIL and prevalence of HPV infection.

Results: Anal Cytology was abnormal in 126 of 177 (71%) HIV positive MSM, including high-grade SIL in 39 (22%), low grade SIL in 74 (42%), and atypical squamous cells of undetermined significance in 12 patients (7%). HPV DNA was detected in 142 of 177 (80%).

Conclusion: Our results demonstrate a high prevalence of anal SIL, including high-grade SIL and anal HPV infection in HIV infected MSM with decreased CD4 Cell Count.