Journal
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Volume 71, Issue 5, Pages 570-576Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0000000000000910
Keywords
anal cancer; HIV; MSM; HPV; screening; MACS; anal cytology; anal dysplasia
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Funding
- National Cancer Institute (NCI)
- National Institute of Allergy and Infectious Diseases (NIAID)
- National Institute on Drug Abuse (NIDA)
- National Institute of Mental Health (NIMH)
- National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH) [UL1-TR001079]
- NIH Roadmap for Medical Research
- Merck Co. [IISP 38548]
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Objective: 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 HIV-uninfected MSM and increased to 38%, 41%, and 47% among HIV-infected MSM with current CD4(+) T-cell counts >= 500, 350-499, and <350 cells/mm(3) (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 high-grade (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 ASC-US/LSIL progressed to ASC-H/HSIL. Abnormal ACyt had high sensitivity (96%) but low specificity (17%) for biopsy-proven HSIL. Conclusions: Prevalence of abnormal ACyt remains elevated in HIV-infected men during the current antiretroviral therapy era.
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