Anal cancer screening in men who have sex with men in the multicenter AIDS cohort study

Gypsyamber D'Souza, Alicia Wentz, Dorothy Wiley, Nisha Shah, Francine Barrington, Teresa M. Darragh, Nancy Joste, Michael Plankey, Susheel Reddy, Elizabeth C. Breen, Stephen Young, Ross D. Cranston

Research output: Contribution to journalArticlepeer-review

Abstract

To evaluate the prevalence of anal cytology (ACyt) abnormalities among HIV-infected and HIV-uninfected men who have sex with men (MSM). Design: Multicenter cohort study of 723 HIV-infected and 788 HIV-uninfected MSM with ACyt, with a second ACyt collected 2 years later. A referral for high-resolution anoscopy was suggested for abnormal ACyt. Methods: ACyt samples were collected using a polyester swab and liquid cytology media and read in a central laboratory. Results: Prevalence of any abnormal ACyt was 25% in HIVuninfected MSM and increased to 38%, 41%, and 47% among HIVinfected MSM with current CD4+ T-cell counts ≥500, 350-499, and <350 cells/mm3 (P < 0.001), respectively. Anal HPV16 DNA was also more common in HIV-infected than HIV-uninfected MSM (25% versus 16%, P < 0.001). Abnormal baseline ACyt together with prevalent HPV16 DNA detection was present in only 7% of HIV-uninfected MSM compared to 18% of HIV-infected MSM with current CD4 < 350, P < 0.001. Among HIV-infected men, 56% of the men with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions ASCs-US/LSILs and 81% of men with atypical squamous cells cannot exclude highgrade (ASC-H/)/high-grade squamous intraepithelial lesions (HSIL) had lower grade ACyt findings 18-30 months later ("regressed"). However, 19% of untreated HIV-infected men with ASC-H/HSIL cytology maintained that same grade of cytology in their second test approximately 2 years later, and 15% with ASCUS/ LSIL "progressed" to ASC-H/HSIL. Abnormal ACyt had high sensitivity (96%) but low specificity (17%) for biopsyproven HSIL. Conclusions: Prevalence of abnormal ACyt remains elevated in HIV-infected men during the current antiretroviral therapy era.

Original languageEnglish (US)
Pages (from-to)570-576
Number of pages7
JournalJournal of acquired immune deficiency syndromes
Volume71
Issue number5
DOIs
StatePublished - Mar 23 2016

Keywords

  • Anal cancer
  • Anal cytology
  • Anal dysplasia
  • HIV
  • HPV
  • MACS
  • MSM
  • Screening

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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