Risk factors for anal HPV infection and anal precancer in HIV-infected men who have sex with men

Lauren M. Schwartz, Philip E. Castle, Stephen Follansbee, Sylvia Borgonovo, Barbara Fetterman, Diane Tokugawa, Thomas S. Lorey, Vikrant V. Sahasrabuddhe, Patricia Luhn, Julia C. Gage, Teresa M. Darragh, Nicolas Wentzensen

Research output: Contribution to journalArticle

35 Scopus citations


Background. Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM. Methods. Our study included 305 MSM at an HIV/AIDS clinic in the Kaiser Permanente Northern California Health Maintenance Organization. Logistic regression was used to estimate associations of risk factors comparing men without anal HPV infection; men with anal HPV infection, but no precancer; and men with anal precancer. Results. Low CD4 count (<350 cells/mm3) and previous chlamydia infection were associated with an increased risk of carcinogenic HPV infection (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.28-10.40 and OR, 4.24; 95% CI, 1.16-15.51, respectively). History of smoking (OR, 2.71 95% CI, 1.43-5.14), duration, recency, and dose of smoking increased the risk of anal precancer among carcinogenic HPV-positive men but had no association with HPV infection. Conclusions. We found distinct risk factors for anal HPV infection and anal precancer. Risk factors for HPV infection and anal precancer are similar to established risk factors for cervical cancer progression.

Original languageEnglish (US)
Pages (from-to)1768-1775
Number of pages8
JournalJournal of Infectious Diseases
Issue number11
StatePublished - Dec 1 2013
Externally publishedYes



  • Anal cancer
  • Anal intraepithelial neoplasia (ain)
  • Human immunodeficiency virus (hIV)
  • Human papillomavirus (HPV)
  • Men who have sex with men (MSM)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

Cite this

Schwartz, L. M., Castle, P. E., Follansbee, S., Borgonovo, S., Fetterman, B., Tokugawa, D., Lorey, T. S., Sahasrabuddhe, V. V., Luhn, P., Gage, J. C., Darragh, T. M., & Wentzensen, N. (2013). Risk factors for anal HPV infection and anal precancer in HIV-infected men who have sex with men. Journal of Infectious Diseases, 208(11), 1768-1775. https://doi.org/10.1093/infdis/jit374