Infection with Chlamydia trachomatis increases the risk of high grade anal intraepithelial neoplasia in people living with HIV.

OBJECTIVE We aimed to assess the relationship between sexually transmitted infections (STIs), including a large panel of HPV genotypes, and high-grade anal intraepithelial neoplasia (HGAIN) in HIV-positive men who have sex-with-men (MSM). METHODS In a prospective study in an HIV cohort, participants underwent high-resolution anoscopy (HRA) for anorectal swabs collection to investigate STIs and for anal biopsy. Multiplex real-time PCR detecting several STIs and 28 HPV genotypes were performed. Univariate and multivariate generalized linear models were used to analyse the relationship of variables of interest with HGAIN. RESULTS 145 participants were included; in 49, two HRAs were performed. Ureaplasmaurealyticum (UU) was detected in 25 (17.2%) participants, Chlamydia trachomatis (CT) in 13 (9.0%), Mycoplasma genitalium (MG) in 4 (2.8%), HPV16 in 38 (26.2%), HPV52 in 29 (20%), and HPV53 and HPV42 in 28 (19.3%) participants each. Thirty-five (24.1%) subjects were diagnosed with HGAIN. In the univariate analysis, HGAIN was associated with CT, UU, MG, HPV16, HPV53, HPV68, HPV70, and a significant interaction was found between CT and HPV16 (OR 31.0; 95% CI, 4.3-221.7), and between UU and HPV16 (OR 8.8, 95% CI, 2.1-37.5). In the adjusted model, CT, HPV16, HPV53, HPV70, the CD4+/CD8+ ratio, and the interaction between CT and HPV16 remained independent predictors of HGAIN. HPV16, HPV53 and HPV70 persisted in all the participants with recurrent HGAIN in the second HRA. CONCLUSION Coinfection with CT may potentiate the oncogenic capability of HPV16 and increase the risk of HGAIN in people with HIV. HPV53 and HPV70 should be considered among the genotypes associated with HGAIN.

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