Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts ThPeC7542-ThPeC7545 471

ual behaviour, and HIV status on anogenital infection. Anal warts are associated
with human papillomavirus (HPV) which has been linked to the development of
anal cancer. Although risk factors are currently uncharacterized in Canada, highrisk sexual practices & other STDs are implicated in HPV pathogenesis.
Methods: Men aged 15 to 30 years, who had not previously tested HIV +, were
enrolled in a prospective cohort in Greater Vancouver. Eligible participants completed baseline questionnaires & at least one follow-up questionnaire between
05/95 & 09/01. Using Chi-Square analysis, data from the two most recent questionnaires was used to identify characteristics and risk factors of men with selfreported anogenital warts.
Results: Few participants (27/168) reported ever having an anal Pap smear. No
significant differences were found between HIV + & HIV - men in testing for or
reporting anal warts. Men reporting anogenital warts were more likely to be Caucasian (83% vs. 73%, p=0.04), have gonorrhea (26.5% vs. 10.6%, p=0.001) &
herpes (14.7% vs. 3.5%, p=0.001), have had 20 or more male sexual partners in
their lifetime (82.5% vs. 67.2%, p=0.003), & have had protected or unprotected
casual anal insertive intercourse with a known HIV infected partner (61.2% vs.
45.8%, p=0.005). They were also more likely to report the use of nitrate inhalants
(43% vs. 31 %, p=0.026), ecstasy (43.7% vs. 31.4%, p=0.02), ketamine (27.7%
vs. 13.1%, p=0.001), & gamma-hydroxybuturate (22.6% vs. 14.5%, p=0.049), although these drugs may in fact be markers for higher sexual activity.
Conclusion: To reduce HPV rates, prevention efforts designed for young MSM
should incorporate issues relating to substance use, & encourage treatment of
other STDs.
Presenting author: elissa press, 608-1081 burrard street, st paul's hospital, vancouver, bc, v6z ly6, Canada, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeC7542 High prevalence of vulvar neoplasia in HIV-positive
women: study on 554 patients
A. Agarossi, E. Casolati, M. Valieri, V. Savasi, C. Mastromatteo, E. Ferrazzi.
OB&GYN ISBM Sacco, OB&GYN, ISBM L. Sacco, Via grassi 74, Milan, Italy
Background: The aim of this study was to assess, on a large HIV infected population, the prevalence of VIN and other vulvar diseases.
Methods: Five hundred and fifty-four HIV-positive women underwent a complete
gynaecological examination with Pap smear, colposcopy, and colposcopic examination of the vulva and perianal region. All gross or colposcopic abnormalities,
except typical condiloma, were biopsied. Behavioural, clinical and immunological
characteristics were recorded.
Results: A history of STD was reported by 246 (44%) women, mainly condiloma
acuminata (84%) and genital herpes (22%). Vulvar HPV infection was found in
234 patients (42%), 54% of whom had multiple and/or extensive lesions. A multicentric involvement of the lower genital tract was present in 173 women. Genital
herpes was diagnosed in 45 (8.3%) patients and molluscum contagiosum in 5
(1%). VIN was diagnosed in 39 (7%) women: 15 VIN-1, 11 VIN-2 and 13 VIN-3. A
superficially invasive carcinoma was found in a patient treated for VIN-3. One additional Buscke-Loewenstein tumor and one vulvar Kaposi's sarcoma were also
found. 55% of women with a CD4 count <200 compared to 29% with a CD4 count
>500 had vulvar condylomas (p<.001), 16% vs 2% had genital herpes (p<.001)
and 12% vs 4% had VIN (p<.001), respectively.
Conclusions: The prevalence of vulvar disease in HIV-positive women demands
accurate vulvar examination. The risk for HPV infection, genital HSV infection and
vulvar neoplasia is strongly associated with immunodepression.
Presenting author: Alberto Agarossi, OB&GYN, ISBM L. Sacco, Via grassi 74,
Milan, Italy, Tel.: [phone], E-mail: [email protected]
ThPeC7543 Hormonal contraceptive use and IL-12
concentration in cervical secretions are associated
risks for high grade squamous intra-epithelial
lesions
A.B. Moscicki', P. Crowley-Nowick2, S.D. Douglas3. 1University of California,
San Francisco, University of California San Francisco, 3333 California Street,
Suite 245, San Francisco, CA 94118, United States; 2Harvard School of
Medicine, Boston, United States; 3Childrens Hospital of Philadelphia,
Philadelphia, United States
Background: To determine the biologic and behavioral risks for incident low
grade squamous intra-epithelial lesions (LSIL) and high grade (H) SIL.
Methods: Incident LSIL and HSIL were defined on cytology in a multi-city NIHfunded longitudinal study of HIV infection in adolescents (REACH). HIV infected
adolescents aged 13-18 years who acquired HIV primarily through sexual contact
and a matched HIV uninfected group were followed with interview and examination every 6 months for peripheral blood CD4+, CD8+, CD 8+/CD38+ cells, cytology, HPV testing, IL-10 and IL-12 levels from cervical mucous and sexually transmitted infection testing. Risks for 1st detected LSIL and HSIL were performed

using Cox Proportional Hazards methods. Prevalent cases of LSIL at baseline
were excluded for the LSIL but not HSIL analysis.
Results: 41 (16%) of the 256 who met inclusion for the HSIL study developed
HSIL; and 26 (21%) of the 125 eligible for LSIL developed LSIL. Rate of HSIL
was higher for HIV infected than uninfected (21.5% vs 4.8%;p<0.001) but not
LSIL. Subjects with LSIL at baseline were much more likely to develop HSIL
than those with normal cytology (30.4% vs 6.9%,p<0.001). Multivariate analysis

showed that risks for HSIL included hormonal contraceptive use (RH 2.4;p=0.02),
high IL-12 concentrations (RH 2.3;p=.02), positive HPV test (RH 4.8;p=0.004) and
LSIL at baseline (RH 2.1;p=0.04). Risks for LSIL included current oral contraceptives (3.9;p=.005) and positive HPV test (RH 5.6;p=0.001). CD4 count, HPV type
and HPV persistence did contribute to the risk for LSIL or HSIL.
Conclusion: Incidence of HSIL was equal to that of LSIL in HIV infected girls.
The association with high IL-12 levels in cervical secretions but lack of association with CD4 count or HPV type suggests that there is an HIV-associated immune
dysregulation that occurs in the mucosal immune environment. The association
with hormonal contraceptive use is troubling.
Presenting author: Anna-Barbara Moscicki, University of California San Francisco, 3333 California Street, Suite 245, San Francisco, CA 94118, United States,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeC7544I Anal cytology screening as a useful test for
diagnosis of anal dysplasia in HIV positive patients
R. Alfonzol, M. Uribel, M.E. Cavazza2, M. Correnti3, J.D. Thorsell', D. Garcia1,
J. Soteldol. 'Hospital de Clinicas Caracas, Hospital de Clinicas Caracas, Edif.
Anexo, piso 11, oficina 1100, San Benardino, Caracas 1011, Venezuela,
Apartado Postal: 16006, Venezuela; 2Servicio Autonomo Instituto de
Biomedicina, Caracas, Venezuela; 3 nstituto de Oncologia y Hematoogia,
Caracas, Venezuela
Introduction: The risk of anal carcinoma has traditionally been underestimated
in the general population but more importantly in HIV positive patients.
Objectives: To detrmine the necessity of the anal cytology screening for early
detection of dysplasic changes and prevention of anal carcinoma in HIV positive
patients more specifically in MSM.
Methods: We performed 162 anal cytologies and PCR testingin HIV positive patients between July 1999 and December 2000.
Results: 38.8% reported HSIL, 16.6% LSIL, 3.7% reported anal carcinoma and
35.1% were normal. All of the cytologies were tested with PCR for the presence
of HPV, where 25.9% were highly reactive, 44.4% low reactive, 18.5% had mixed
reaction, and 25.9% tested negative.
Conclusions: Anal cytology constitutes an important and necessary screening
method for the early detection and prevention of anal carcinoma in HIV positive
patients.
Presenting author: Ricardo Alfonzo, Hospital de Clinicas Caracas, Edif. Anexo,
piso 11, oficina 1100, San Benardino, Caracas 1011, Venezuela, Apartado Postal:
16006, Venezuela, Tel.: [phone], Fax: [phone], E-mail: ricalf
@cantv.net
ThPeC7545I Atypical Squamous Cells of Undertermined
Significance (ASCUS) in HIV-infected women and
women at risk for HIV infection
A. Duerr', J. Anderson2, P. Paramsothy3, S. Cu-Uvin4, R.S. Klein5,
P. Schuman6. 1'CDC, CDC, MS K-34, 4770 Buford Highway Atlanta, GA 30341,
United States; 2Johns Hopkins University, Baltimore, United States; 3CONRAD,
Atlanta, United States; 4Brown University, Providence, United States;
5 Montefiore Medical Center, Bronx, United States; 6 Wayne State University
School of Medicine, Detroit, United States
Background: ASCUS is a cervical cytologic finding of atypia of undetermined or
mixed etiology that may be a precursor of squamous intraepithelial lesions (SIL).
ASCUS remains an incompletely described entity among HIV-uninfected (HIV-)
women; even less is known about ASCUS in HIV-infected (HIV+) women.
Methods: Cervical Pap smear and colposcopy data are from the first 10 semiannual visits of the HIV Epidemiology Research study for 774 HIV+ and 480 demographically similar HIV- U.S. women. We examined the risk of ASCUS, its
characteristics and progression in HIV+ and HIV- women.
Results: ASCUS was more common among HIV+ women; OR=1.7 [95% CI:1.4,
2.1] after adjustment for HPV and other risk factors (e.g. race, condyloma, prior
Pap result). Among HIV+ women who had a normal Pap smear at study entry,
27% developed ASCUS during follow-up compared to 8.6% of the HIV- women
(p<.01). HIV+ and HIV- women with ASCUS did not differ in prevalence of indices
of inflammation (inflammation on pap smear, leukocytes on cervical gram stain)
and indices of dysplasia (aceto-white, punctation, mosaicism or atypical vessels
on colposcopy, CIN on biopsy). Among women with ASCUS at enrollment, 48%
of HIV+ and 70% of HIV- women had normal Pap smears during follow-up; 28%
of HIV+ and 4% of HIV- women ultimately developed SIL (p<.01). Compared to
HIV+ women with higher CD4 counts, HIV+ women with CD4 < 200 cells/kL were
more likely to have SIL on subsequent Pap smear (OR=2.9 [1.1, 7.5]).
Conclusion: The higher risk of SIL among HIV+ women with ASCUS, especially
those with low CD4 count, may merit more intense follow-up in these women to
allow early detection and treatment of SIL.

Presenting author: Yusuf Ahmed, CDC, MS K-34, 4770 Buford Highway, Atlanta,
GA 30341, United States, Tel.: [phone], Fax: [phone], E-mail:
[email protected]