Human Papillomavirus Infection and Related Anal Lesions in HIV-positive Men Who Have Sex With Men

Multicentric epidemiological non-comparative study in France characterising evolution of anal Human papillomavirus (HPV) infection and related lesions and evaluating markers associated with the observed evolution. Estimated enrolment: 500 Principal Outcomes * Detection of high-grade cytological and histological anal lesions by high resolution anoscopy * Spontaneous regression of high-grade anal lesions * Detection of anal HPV infection Intervention (procedure): * Patient medical interview (initial inclusion visit, Month 12 and Month 24 follow-up visits and if applicable Month 6 and Month 18 control visits) * Standard proctologic examination with digital rectal examination and 2 anal swabs (initial inclusion visit, Month 12 and Month 24 follow-up visits and if applicable Month 6 and Month 18 control visits) * High resolution anoscopy (initial inclusion visit, Month 12 and Month 24 follow-up visits and if applicable Month 6 and Month 18 control visits) Only if lesion suggestive of Anal Intraepithelial Neoplasia (AIN) detected during High Resolution Anoscopy (HRA): \- anal biopsy(ies) during HRA Only if high-grade lesion: \- HRA biannually

Sex

Male

Minimum age

35 Years

Maximum age

80 Years

Inclusion Criteria:

* Men who have sex with men
* At least 35 years old
* HIV-positive (documented search of HIV infection, with HIV status determined according to HAS algorithm)
* Signed informed consent
* Affiliated to or beneficiary of French social security
* All severity criteria and evolution of HIV disease are accepted (including AIDS stage and co-infections)

Exclusion Criteria:

* Contraindication to biopsy
* History of anal cancer or pelvic radiotherapy
* AIN2/3 treated during previous year
* Current anticancer chemotherapy or within 24 months before inclusion
* Difficulty in evaluation (anus reshaped and/or scarred)
* Individual placed under judicial protection
* Foreseen absence which may hamper participation; insufficient motivation; associated pathology with priority for care

• BACKGROUNDCombes JD, Didelot JM, Radenne S, Zaegel-Faucher O, Lesage AC, Siproudhis L, Piroth L, Marchand L, Heard I, Hoyeau N, Henno S, Darragh TM, Alberts CJ, Clifford GM, Etienney I; ANRS-EP57-APACHES Study group. Cumulative Detection of Anal High-Grade Squamous Intraepithelial Lesions Over 2-Year Follow-up in Men Who Have Sex With Men Living With Human Immunodeficiency Virus in France. J Infect Dis. 2024 Jul 25;230(1):55-60. doi: 10.1093/infdis/jiad506. PMID 39052708
• RESULTAlberts CJ, Heard I, Canestri A, Marchand L, Flejou JF, Piroth L, Ferry T, Didelot JM, Siproudhis L, Henno S, Poizot-Martin I, Darragh TM, Clifford GM, Combes JD, Etienney I; ANRS EP57 APACHES Study group. Incidence and Clearance of Anal Human Papillomavirus (HPV)-16 and HPV-18 Infection, and Their Determinants, Among Human Immunodeficiency Virus-Infected Men Who Have Sex With Men in France. J Infect Dis. 2020 Apr 7;221(9):1488-1493. doi: 10.1093/infdis/jiz623. PMID 31754686
• RESULTClifford GM, Siproudhis L, Piroth L, Poizot-Martin I, Radenne S, Reynes J, Lesage A, Heard I, Henno S, Flejou JF, Marchand L, Combes JD, Etienney I; ANRS EP57 APACHES Study group. Determinants of high-grade anal intraepithelial lesions in HIV-positive MSM. AIDS. 2018 Oct 23;32(16):2363-2371. doi: 10.1097/QAD.0000000000001947. PMID 30005009
• RESULTCombes JD, Heard I, Poizot-Martin I, Canestri A, Lion A, Piroth L, Didelot JM, Ferry T, Patey O, Marchand L, Flejou JF, Clifford GM, Etienney I; ANRS EP57 APACHES Study group. Prevalence and Risk Factors for Anal Human Papillomavirus Infection in Human Immunodeficiency Virus-Positive Men Who Have Sex with Men. J Infect Dis. 2018 Apr 23;217(10):1535-1543. doi: 10.1093/infdis/jiy059. PMID 29394362