Negative Predictive Value of Human Papillomavirus Testing: Implications for Anal Cancer Screening in People Living with HIV/AIDS

Wang, Yiying; Wang, Yan; Gaisa, Michael; Sigel, Keith; Zheng, Wenxin; Liu, Yuxin; Wang, Yue

doi:10.1155/2020/6352315

Cited by 7 publications

(6 citation statements)

References 35 publications

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“…This was unexpected given high hrHPV prevalence among MSM LWH inferring excellent positive predictive value of true hrHPV infection, but correspondingly poor specificity [ 25 ]. Nonetheless, Wang et al reported a 92% negative predictive value of hrHPV positivity for anal HSIL among 156 PLWH, with no anal cancers detected [ 26 ]. In a separate prospective study, when incorporated into anal cancer screening algorithms for high risk groups, hrHPV testing increased sensitivity for histologic HSIL and anal cancer, though decreased specificity when compared to anal cytology alone [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Provider preferences for anal cancer prevention screening: Results of the International Anal Neoplasia Society survey

Plotzker¹,

Barnell

Wiley

et al. 2022

Tumour Virus Research

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Section: Discussionmentioning

confidence: 99%

Provider preferences for anal cancer prevention screening: Results of the International Anal Neoplasia Society survey

Plotzker¹,

Barnell

Wiley

et al. 2022

Tumour Virus Research

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“…Another study of hrHPV PCR testing in HIV‐positive MSM established a high sensitivity (98.4–100%) and low specificity (26–28.9%) in the identification of AIN2/3 74 . Another found a negative predictive value of 92% in a cohort of HIV‐positive patients 75 . This reflects the high prevalence of HPV infection in HIV‐positive MSM, which complicates the utility of HPV screening; in one meta‐analysis, prevalence of any HPV and HPV16 in HIV‐positive MSM was estimated to be 81% and 30%, respectively 76 .…”

Section: Preventionmentioning

confidence: 99%

“…74 Another found a negative predictive value of 92% in a cohort of HIV-positive patients. 75 This reflects the high prevalence of HPV infection in HIV-positive MSM, which complicates the utility of HPV screening; in one meta-analysis, prevalence of any HPV and HPV16 in HIV-positive MSM was estimated to be 81% and 30%, respectively. 76 Further investigation is warranted regarding the use of HPV screening in immunologically intact men and women, particularly in the MSM population who are also at an increased risk for anal HPV acquisition.…”

Section: Anal Cytologymentioning

confidence: 99%

Anal cancer screening and prevention: a review for dermatologists

McGovern

Fuller

Burris

2021

Acad Dermatol Venereol

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The incidence of and mortality from anal cancer, predominantly squamous cell carcinoma (SCC), have been increasing since the 1980s, during an era when many common malignancies have seen decreases in mortality. Dermatologists may be more likely to see patients at an increased risk for anal SCC, such as those living with HIV, MSM and those presenting for management of anogenital warts, yet there is little guidance in the field on how to manage these patients. We underwent a project to review the evidence surrounding screening and prevention of anal SCC. HPV vaccination, the main preventative measure for anal SCC, is often underutilized and may not be effective for those most at risk. Screening methods currently include high-risk HPV and anal cytology testing, with high-resolution anoscopy (HRA) reserved for biopsy and confirmatory testing. High-risk HPV testing has been associated with high sensitivity for intraepithelial neoplasia, but low specificity in high-risk groups. Recent meta-analyses examining AIN detection using anal cytology estimate a similarly high sensitivity of 74-87%, with a relatively higher specificity (44-66%) for identifying high-grade AIN.HRA is the gold standard for diagnosis, but its accessibility and cost are deterrents from its use as a screening tool. Cervical cancer screening, initially adopted without significant evidence of its impact, has significantly decreased cervical cancer rates. The argument can be made that rates of anal SCC may also benefit from appropriate screening methods, particularly anal cytology. It is prudent for dermatologists to be aware of the methods available to them in the management of at-risk patients, the data supporting them, and the potential benefits of screening in order to counsel patients appropriately and address the increasing burden of disease.

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“…22,23 Existing screening strategies used for cervical cancer have been studied for anal cancer, including anal cytology [aCyt] and HPV DNA from an anal swab, with some studies suggesting potential benefit 22,23 and others not. [24][25][26] The prevalence of oncHPV infection is high among MSM. 27,28 Thus, oncHPV testing alone may be highly sensitive, but has poor specificity for anal cancer screening among MSM.…”

Section: Introductionmentioning

confidence: 99%

Comparison of anal pre-cancer screening strategies among men who have sex with men

Sun

Wiley²,

Barrett

et al. 2022

Int J STD AIDS

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Purpose Comparison of anal pre-cancer screening strategies in men who have sex with men (MSM). Methods MSM in the Multicenter AIDS Cohort Study underwent repeated anal cytology (aCyt), oncogenic human papillomavirus (oncHPV) testing. A subset received High-Resolution Anoscopy (HRA). We evaluated three screening strategies for their ability to predict anal histological High-Grade Squamous Intraepithelial lesion (HSIL): single aCyt, sequential aCyt, and oncHPV co-testing. Multivariable logistic regression models evaluated risk of HSIL among participants undergoing HRA within 5 years of screening. Sensitivity and specificity were estimated among participants with HRA, and results corrected for verification bias using weighted generalized estimating equations. Results There were 1426 MSM with aCyt screening (48% people with HIV [PWH]) and 428 that underwent HRA. Median age was 57 years, 14% of PWH had CD4< 350 cells/mm3. HSIL probability was higher in MSM with one (39%, p < 0.01) or two abnormal aCyt results (46%, p < 0.01), versus those with normal aCyt (23–24%). Among men with abnormal aCyt, men with oncHPV+ had significantly higher risk than those who were oncHPV- (47% vs. 16%, p < 0.01). Specificity was modest with single aCyt+ (50%) but increased with sequential aCyt+ (79%) or oncHPV+ (67%). Sensitivity was high with single oncHPV+ (88%), moderate with single aCyt+ (66%) and oncHPV+ co-testing (61%), and low with sequential aCyt+ (39%). After correcting for potential verification bias, specificity increased and sensitivity decreased, but inferences were similar. Conclusion None of the screening strategies evaluated had both sufficient specificity and sensitivity to warrant routine widespread use.

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Negative Predictive Value of Human Papillomavirus Testing: Implications for Anal Cancer Screening in People Living with HIV/AIDS

Cited by 7 publications

References 35 publications

Provider preferences for anal cancer prevention screening: Results of the International Anal Neoplasia Society survey

Provider preferences for anal cancer prevention screening: Results of the International Anal Neoplasia Society survey

Anal cancer screening and prevention: a review for dermatologists

Comparison of anal pre-cancer screening strategies among men who have sex with men

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