TY - JOUR

T1 - Risk of Anal High-grade Squamous Intraepithelial Lesions Among Renal Transplant Recipients Compared With Immunocompetent Controls

AU - Larsen, Helle K

AU - Hædersdal, Merete

AU - Thomsen, Louise T

AU - Hertzum-larsen, Rasmus

AU - Lok, Trine Thorborg

AU - Bonde, Jesper

AU - Sørensen, Søren S

AU - Hansen, Jesper Melchior

AU - Palefsky, Joel M

AU - Kjær, Susanne K

PY - 2021

Y1 - 2021

N2 - BackgroundRenal transplant recipients (RTRs) have increased risk of human papillomavirus (HPV)–related cancers, including anal cancer. We investigated the prevalence of anal high-grade intraepithelial lesions (HSILs) in RTRs compared with immunocompetent controls and risk factors for anal HSIL in RTRs.MethodsWe included 247 RTRs and 248 controls in this cross-sectional study. We obtained anal samples for HPV testing with INNO-LiPA and performed high-resolution anoscopy on all participants. The participants completed a questionnaire on lifestyle and sexual habits. We used logistic regression to estimate odds ratios (ORs) of histologically confirmed anal HSIL in RTRs vs controls and risk factors for anal HSIL in RTRs, stratified by sex and anal high-risk (hr) HPV status, adjusting for age, smoking, lifetime sexual partners, and receptive anal sex.ResultsRTRs had higher anal HSIL prevalence than controls, both among men (6.5% vs 0.8%; adjusted OR [aOR], 11.21 [95% confidence interval {CI}, 1.46–291.17]) and women (15.4% vs 4.0%; aOR, 6.41 [95% CI, 2.14–24.10]). Among those with anal hrHPV, RTRs had higher anal HSIL prevalence than controls (33.8% vs 9.5%; aOR, 6.06 [95% CI, 2.16–20.27]). Having had receptive anal sex (aOR, 6.23 [95% CI, 2.23–19.08]) or genital warts (aOR, 4.21 [95% CI, 1.53–11.48]) were risk factors for anal HSIL in RTRs. All HSIL cases occurred in individuals with anal hrHPV.ConclusionsRTRs had increased risk of anal HSIL compared with immunocompetent controls, with particularly high prevalence in female RTRs. Receptive anal sex, previous genital warts, and anal hrHPV infection were risk factors for anal HSIL in RTRs. Screening for anal HSIL in RTRs should be considered.

AB - BackgroundRenal transplant recipients (RTRs) have increased risk of human papillomavirus (HPV)–related cancers, including anal cancer. We investigated the prevalence of anal high-grade intraepithelial lesions (HSILs) in RTRs compared with immunocompetent controls and risk factors for anal HSIL in RTRs.MethodsWe included 247 RTRs and 248 controls in this cross-sectional study. We obtained anal samples for HPV testing with INNO-LiPA and performed high-resolution anoscopy on all participants. The participants completed a questionnaire on lifestyle and sexual habits. We used logistic regression to estimate odds ratios (ORs) of histologically confirmed anal HSIL in RTRs vs controls and risk factors for anal HSIL in RTRs, stratified by sex and anal high-risk (hr) HPV status, adjusting for age, smoking, lifetime sexual partners, and receptive anal sex.ResultsRTRs had higher anal HSIL prevalence than controls, both among men (6.5% vs 0.8%; adjusted OR [aOR], 11.21 [95% confidence interval {CI}, 1.46–291.17]) and women (15.4% vs 4.0%; aOR, 6.41 [95% CI, 2.14–24.10]). Among those with anal hrHPV, RTRs had higher anal HSIL prevalence than controls (33.8% vs 9.5%; aOR, 6.06 [95% CI, 2.16–20.27]). Having had receptive anal sex (aOR, 6.23 [95% CI, 2.23–19.08]) or genital warts (aOR, 4.21 [95% CI, 1.53–11.48]) were risk factors for anal HSIL in RTRs. All HSIL cases occurred in individuals with anal hrHPV.ConclusionsRTRs had increased risk of anal HSIL compared with immunocompetent controls, with particularly high prevalence in female RTRs. Receptive anal sex, previous genital warts, and anal hrHPV infection were risk factors for anal HSIL in RTRs. Screening for anal HSIL in RTRs should be considered.

U2 - 10.1093/cid/ciaa781

DO - 10.1093/cid/ciaa781

M3 - Journal article

C2 - 32544223

VL - 73

SP - 21

EP - 29

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 1

ER -