Prevalence of anal intraepithelial neoplasia in HIV positive men who have sex with men attending comprehensive care clinics in Nairobi

Abstract

Background: Men who have Sex with Men (MSM) populations exist in virtually all cultures and communities. Men who have sex with Men have a heavy burden of HIV and associated conditions including anal squamous cell carcinoma and its precursor lesions. High risk HPV infection associated causally with both invasive squamous carcinoma and its precursor lesions has been identified in 70% of all MSM irrespective ofHIV status. Highly Active anti-Retroviral Therapy (HAART) does not significantly alter the pathogenesis of ASIL, HPV infections or SCC. As more and more HIV positive MSM continue to live longer due to HAART, the prevalence of ASIL, HPV infections and SCC is expected to rise. It is expected that screening with the aim of detecting early precursor lesions and treating them before they become invasive cancer will reduce the prevalence, morbidity and mortality associated with invasive squamous cell carcinoma Screenfug-~ing pap smears is expected to achieve similar success to that of cervical pap smears. Objective: To determine the prevalence of anal intraepithelial neoplasia in HIV positive Men who have Sex with Men (MSM) attending comprehensive care clinics in Nairobi. Design and methods: A cross sectional-descriptive study was done. A total of ninety four HIV positive MSM who met the inclusion criteria were recruited using respondent-driven sampling, and completed a questionnaire, detailing their socio-demographic data, sexual practice and medical history. Conventional smears were prepared for anal cytology and stained with Pap stain. Slides were reviewed by the principal investigator and two cytopathologists. In case of any discrepancy, an independent cytopathologist reviewed ~ slides. Setting: KNH CCC, Casino STC clinic and Kenyatta National Hospital Cytology Laboratory. Results: Ninety four eligible participants who gave consent were included in the study. Forty, (44%) showed normal anal cytology, 51 (56%) had abnormal anal cytology as follows: ASC-US, 16(17.6%), LSIL, 29 (31.8%) and HSIL 6 (6.6%), while 3 (3.2%) had unsatisfactory smears. candida was the most frequent organism accounting for 77%. 1 butschlii cysts were observed in 11% of smear, while coccobacilli were in 6% of smears. Conclusion: The prevalence of AIN is high, among HIV positive MSM in Kenya, similar to that reported in western countries. Recommendation: Routine screening for high- risk MSM is recommended, and screening and treatment for candidiasis, an opportunistic infection in HIV positive person should be done.