Approximately 14 percent of heterosexual men in a Brazilian cohort study were diagnosed with anal lesions likely caused by human papilloma virus (HPV), according to a report published in the March 2008 issue of the International Journal of STD & AIDS.  These new data, the authors of the small study conclude, justify the screening for anal lesions in all men with HIV infection, not just men with a history of sex with other men.

HPV infection of the anus, a major cause of pre-cancerous (dysplasia) and cancerous anal lesions, has been well-established among men who have sex with men. Nearly all HIV-positive men with a history of receptive anal intercourse have anal HPV infection, according to statistics published by the University of California, San Francisco, Anal Neoplasia Research and Treatment Group. What’s more, 60 percent of HIV-positive men without a history of receptive anal intercourse have anal HPV infection, likely as a result of the virus migrating from another part of the genitals to the anus.

Until recently, little has been known about the prevalence of HPV infection among HIV-positive heterosexual men without a history of receptive male intercourse.

A team of researchers at the Federal University of Pernambuco in Northeastern Brazil conducted a study evaluating the prevalence of HPV-related lesions in a diverse group of 60 men living with HIV/AIDS.  All patients underwent cytology (anal Pap smears), anal biopsies and anoscopy (close visual inspection using a colposcope) to detect for HPV lesions inside the anus.

The volunteers averaged 50 years of age upon entering the study. Gay-identified men represented 43 percent of the volunteers, 15 percent identified as bisexual and 42 percent said they were exclusively heterosexual.

By cytology, 17 percent were found to have HPV-related anal lesions. Anoscopy yielded an HPV-related anal lesion prevalence of 35 percent. Biopsies—considered to be the most accurate diagnostic tool—suggested an anal lesion prevalence of 23 percent.

While 85 percent of the biopsy-confirmed HPV lesions were documented in the gay and bisexual men, more than 14 percent were taken from the heterosexual men in the study. “One can argue that this could reflect incorrect information about sexual practices,” the study authors write, suggesting that the men who identified themselves as heterosexual may not have been forthcoming with information about sexual activity with other men. But they add, “it may in fact be real and suggests perhaps that heterosexual men should also be routinely screened for [HPV-related anal lesions].”