We are in the fourth and final year of a study of the relationship between
human immunodeficiency virus (HIV), and types of human papillomavirus
(HPV), immunosuppression, and risk of development of high grade anal
squamous intraepithelial lesions (HGASIL), the anal cancer precursor
lesion most closely related to invasive anal cancer (R01CA55488, Nancy
Kiviat PI). Our major findings included: a) development of high grade
anal squamous intraepithelial lesions (HGASIL) is associated with HIV
seropositivity, with HIV seropositive men with CD4 count below 500/mul at
greatest risk; b) among both HIV seropositive and HIV seronegative men,
development of HGASIL associated with high levels of HPV types 16/18; (c)
development of HGASIL is associated with low risk HPV type HPV in addition
to HPV 16/18 among HIV seropositive, but not among seronegative men; and
d) HIV seronegative were much more likely to regress from HGASIL to normal
than were HIV seropositive men. We now propose a survey of questions
focused on further exploring the relationship between HIV and HPV. We
will: 1) test the hypothesis that the development of ASIL is associated
with the presence and amount of HIV; 2) determine whether there is support
of the hypothesis that the effect of anal HIV on anal HPV is (a) the
result of local HIV induced immunosuppression (b) direct effect of HIV on
HPV; and 3) initiate studies examining the characteristics, pathogenesis
and clinical consequences of anal HIV variants: by cross sectional
analysis of first visit samples. In summary, we propose a survey of
questions that are likely to contribute significantly to our understanding
of both general HIV pathogenesis and the development of HPV-related
pathology among HIV-seropositive men.
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