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  • Title: The Addition of High-Risk HPV Testing to Anal Cytology Increases the Identification of Anal Dysplasia in HIV-Infected Patients.
    Author: Anthony P, Feinn R, Brenner B, Dieckhaus KD, Chirch LM.
    Journal: Conn Med; 2015 Aug; 79(7):389-94. PubMed ID: 26411174.
    Abstract:
    BACKGROUND: Anal dysplasia (AD) is prevalent in HIV-infected patients. Screening for AD is recommended for high-risk groups, including HIV-infected patients. We evaluated screening algorithms for AD using cytology, high-risk human papillomavirus (HRH) testing, or both. METHODS: HIV-infected patients were offered AD screening by both anal cytology and PCR-based detection of HRH. Patients with abnormal cytology (AC) or HRH genotypes were referred to the same oncologic surgeon for high-resolution anoscopy (HRA). RESULTS: Ninety patients underwent screening (84% men who have sex with men). Forty-four patients (52.6%) had abnormal screens (31.5% AC, 46% HRH). Twenty-six patients with AC and/or positive HRH had HRA. AC and nadir CD4+ cell count of < 200 cells/mm3 were predictors of abnormal histology on HRA by univariate analysis (OR 4.5 and 2.5, respectively). Using a log-linear model, we estimated that for every 49 cases with two normal screening tests, one case of AD would be missed. Conclusions: Universal screening for AD in an HIV+ population yielded a high percentage of abnormal findings. Addition of HRH to cytology screening increased positive screens by 24%. Larger studies are needed to determine the ideal screening method.
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