Low- and high-risk human papillomavirus genotype infections in intra-anal warts in HIV-positive men who have sex with men

Br J Dermatol. 2016 Oct;175(4):735-43. doi: 10.1111/bjd.14567. Epub 2016 Jul 6.


Background: Anogenital warts are often presumed to represent nondysplastic or low-grade anal intraepithelial neoplasia (LGAIN). We previously demonstrated that up to 20% of intra-anal warts in HIV-positive men who have sex with men (MSM) contain regions of high-grade AIN (HGAIN).

Objectives: To determine the causative human papillomavirus (HPV) types of low- and high- grade dysplastic areas in warts from HIV-positive MSM.

Methods: A total of 42 intra-anal warts from 41 HIV-positive MSM were graded as nondysplastic, LGAIN or HGAIN. Whole-tissue sections (WTS) were analysed with the SPF10 polymerase chain reaction/LiPA25 HPV genotyping system. If the WTS contained multiple HPV types, dysplastic regions were isolated by laser capture microdissection (LCM) for HPV genotyping.

Results: Overall, 38 of 42 (91%) WTS tested positive for HPV DNA. Of these, 23 (61%) contained a single HPV type and 15 (39%) contained multiple HPV types. All LCM-selected regions contained no more than one HPV type. Ten of 42 (24%) WTS contained HGAIN disease, of which six (60%) were associated with a high-risk HPV (hrHPV) genotype. Twenty-three of 42 WTS contained LGAIN disease, of which two (9%) were associated with hrHPV. AIN lesions containing hrHPV types were identified using p16 staining.

Conclusions: LGAIN lesions can be caused by high-risk HPV genotypes and vice versa. We therefore recommend routine follow-up and treatment of all dysplastic intra-anal warts for HIV-positive MSM.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Anus Neoplasms / genetics*
  • Anus Neoplasms / virology
  • Carcinoma in Situ / genetics*
  • Carcinoma in Situ / virology
  • Condylomata Acuminata / genetics*
  • DNA, Viral / isolation & purification
  • Genotype
  • HIV Seropositivity / genetics*
  • HIV Seropositivity / virology
  • Homosexuality, Male / genetics*
  • Humans
  • Male
  • Middle Aged
  • Papillomaviridae / genetics
  • Papillomaviridae / isolation & purification
  • Papillomavirus Infections / genetics*
  • Risk Factors


  • DNA, Viral