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Condomless Receptive Anal Intercourse is Associated with Markers of Mucosal Injury in a Cohort of Men Who Have Sex with Men
23 Pages Posted: 19 Oct 2020
More...Abstract
Background: The rectal mucosal immune environment among men who have sex with men (MSM) engaging in condomless receptive anal intercourse (CRAI) is immunologically distinct from that of men who do not engage in anal intercourse (AI).
Methods: We enrolled a cohort of MSM engaging in CRAI (n=41) and men who do not engage in AI (controls; n=21) and used standardized, automated immunohistochemistry and quantitative image analysis to investigate the rectal mucosal distribution of neutrophils (MPO), IL-17-producing cells (IL-17), and Tregs (FOXP3) in the lamina propria, and cellullar proliferation (Ki67) and adherens junctions (E-cadherin) in the epithelium. We also examined associations between biomarker expression and the composition of the rectal mucosal microbiota.
Findings: MSM engaging in CRAI had higher mean expression of MPO in the lamina propria (p=0.04) and Ki67 (p=0.04) in the epithelium relative to controls. There were no differences in IL-17, FOXP3, or E-cadherein expression. We found no statistically significant associations of the five biomarkers with the global rectal microbiota composition or with the individual taxa examined.
Interpretation: Increased infiltration of neutrophils and proliferation of crypt epithelial cells may represent an injury response to frequent CRAI in the rectal mucosa of MSM; however, a contributory role of the microbiota to mucosal inflammation among MSM remains unclear. Prevention may be enhanced by interventions that reduce rectal mucosal inflammation or capitalize on the presence of a specific inflammatory mechanism at the time of HIV exposure.
Funding Statement: This study was funded by the National Institutes of Health (K23 AI108335).
Declaration of Interests: All authors declare no conflict of interest.
Ethics Approval Statement: The Institutional Review Board (IRB) at Emory University approved this study.
Keywords: Receptive anal intercourse, mucosal injury, men who have sex with men, immunohistochemistry
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