The Risk Factors of High-Risk Human Papillomavirus Susceptibility and Clinical Features in People with HIV with Anal Condyloma Acuminatum: A Retrospective Cohort Study

Anal condyloma acuminatum (ACA) has a high incidence and recurrence rate in people living with HIV (PWH) but there are few studies to systematically characterize its clinical features. We aimed to analysis the clinical features in PWH with ACA and elucidate the risk factors of high-risk human papillomavirus (HPV) infection. In total, 208 patients who had ACA surgically excised were enrolled (including 123 ACA subjects with HIV infection) from December 1, 2020, to June 31, 2023, and the sex, age, occupation, marital status, new versus recurrent, HPV genotypes, and treatment history of patients were involved. The HIV viral, CD4 and CD8 cell counts, and the antiretroviral therapy (ART) were also obtained from PWH. PWH with ACA were more likely to be male, employee, and age 19-59 and less likely to be under 18 or over 60 years old (p < .05). The proportion of high-risk HPV infection (30.1%) and triple or more HPV infection (20.5%) in PWH with ACA was significantly higher than those in patients without HIV infection (15.3% and 1.3%, respectively). Moreover, the prevalence of high-risk HPV infection (62.1%) and multiple HPV infection (76.0%) in PWH who were not on ART was significantly higher than those who received ART (20.0%,28.2%, respectively). The conditional logistic regression analysis suggested HIV positivity as the primary risk factor for the high-risk HPV infection in ACA and no ART is a risk factor for high-risk HPV infection. In conclusion, PWH with ACA are more likely to have a high-risk HPV and therefore will be at increased risk for anal SCC, and this risk can in part be mitigated using ART. PWH should start ART as soon as possible after diagnosis. And for PWH with ACA, routine histopathological evaluation and HPV typing of intra-anal warts and follow-up and treatment of all dysplastic warts should be recommended.