The aim of this study was to assess the prevalence of HPV infection and determinants of abnormal cytology in HIV-positive patients. In a cross-sectional study, patients of both sexes, asymptomatic for HPV, underwent anorectal (men)/cervical (women) and oral swabs. Cytology and HPV-PCR detection/genotyping (high- and low-risk genotypes, HR-LR/HPV) were performed. A total of 20% of the 277 enrolled patients showed oral HPV, with no atypical cytology; in men, anal HPV prevalence was 81% with 64% HR genotypes. In women, cervical HPV prevalence was 58% with 37% HR-HPV. The most frequent genotypes were HPV-16 and HPV-18; 37% of men and 20% of women harbored multiple genotypes. Also, 47% of men showed anal squamous intraepithelial lesions (SILs); 6% had high- and 35% low-grade SILs (HSILs/LSILs); 5% had atypical squamous cells of undetermined significance (ASC-US). HR-HPV was independently associated with anal-SIL in men ( ). Moreover, 37% of women showed cervical SIL: 14 ASC-US, 15 LSILs, 4 HSILs, and 1 in situ cancer. The presence of both LR and HR-HPV in women was independently associated with SIL ( and ). HR-HPV and atypical cytology were frequently identified in our cohort. HPV screening should be mandatory in HIV-infected subjects, and vaccine programs for HPV-negative patients should be implemented. 1. Introduction Human papillomavirus (HPV) is one of the most common sexually transmitted pathogens, responsible of several different diseases ranging from benign common warts to invasive carcinoma at a variety of anatomical sites, including the cervix, vulva, vagina, penis, anus, and oropharynx [1]. While the immune system eliminates over time most HPV infections in immunocompetents individuals, HPV infections tend to persist in immunodeficient ones, such as HIV-positive subjects, probably due to the inability to control the expression and replication of HPV by HIV-compromised immune system [2]. Persistent infections with oncogenic HPV genotypes are causally related to the development of high-grade intraepithelial lesions and invasive carcinoma. Many studies have shown a higher incidence of HPV-related cervical cancer [3] in HIV-positive women compared to general population, and in 1993, cervical cancer was included in the list of AIDS defining conditions [4]. Later, attention was paid on anal cancer and its increasing incidence in HIV-positive patients, especially in men who have sex with men (MSM), when compared with HIV-negative controls [5]. Furthermore, the risk of other HPV-associated cancers, like oropharyngeal, has been demonstrated to be increased
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