Prevalence of Abnormal Anal Cytology and High-Grade Squamous Intraepithelial Lesions Among a Cohort of HIV-Infected Men Who Have Sex With Men

Sendagorta, Elena; Pinto, Pedro Herranz; Guadalajara, Héctor; Bernardino, José I.; Viguer, José M.; Beato, María; Garcı́a-Olmo, Damián; Peña, José M.

doi:10.1097/dcr.0000000000000095

Cited by 39 publications

(41 citation statements)

References 35 publications

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“…The prevalence of abnormal ACyt observed among MSM in this study was similar to previous reports of frequent cytologic abnormality (ASC-US+; 41–68%) but low (≤5%) prevalence of HSIL ACyt, 10,26,27 although this is not consistent with some smaller older studies reporting higher prevalence of HSIL ACyt. 28–30 The high proportion of MSM tested who had anal b HSIL in this study is comparable to another study of MSM which reported 16% two year cumulative incidence 31 , and supports the need for effective screening methods in this population.…”

Section: Discussionsupporting

confidence: 77%

Anal Cancer Screening in Men Who Have Sex With Men in the Multicenter AIDS Cohort Study

D’Souza

Wentz

Wiley

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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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 two years later. Referral for high-resolution anoscopy (HRA) 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/mm3 (p<0.001), respectively. Anal HPV16 DNA was also more common in HIV-infected than HIV uninfected MSM (25% vs 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 low grade squamous intraepithelial lesions ASC-US/LSIL and 81% of men with atypical squamous cells cannot exclude high grade (ASC-H/)/high grade SIL (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 at their second test approximately two 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 ART era.

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Section: Discussionsupporting

confidence: 77%

Anal Cancer Screening in Men Who Have Sex With Men in the Multicenter AIDS Cohort Study

D’Souza

Wentz

Wiley

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Similar percentages have been communicated in previous research in seropositive MSM [31]. However, in a population of HIV-negative MSM patients, the prevalence of HPV in anal mucosa was much lower, around 40% [35]. Our patients, similar to others who are immunocompromised, present a higher number of viruses, possibly due to the lower capacity of clearance of the virus from the anal mucosa [36].…”

Section: Discussionsupporting

confidence: 87%

Safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine in HIV-positive Spanish men who have sex with men (MSM)

et al. 2017

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BackgroundSafety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine were evaluated in HIV-positive Spanish MSM. The prevalence of High Squamous Intraepithelial Lesions (HSIL) and genotypes of high-risk human papillomavirus (HR-HPV) were also determined, as well as risk factors associated with the presence of HR-HPV in anal mucosa.MethodsThis is a randomised, double blind, placebo-controlled trial of the quadrivalent HPV (qHPV) vaccine. The study enrolled from May 2012 to May 2014. Vaccine and placebo were administered at 0, 2 and 6 months (V1, V2, V3 clinical visits). Vaccine antibody titres were evaluated at 7 months. Cytology (Thin Prep® Pap Test), HPV PCR genotyping (Linear Array HPV Genotyping Test), and high-resolution anoscopy (Zeiss 150 fc© colposcope) were performed at V1.ResultsPatients (n = 162; mean age 37.9 years) were screened for inclusion; 14.2% had HSIL, 73.1% HR-HPV and 4.5% simultaneous infection with HPV16 and 18. Study participants (n = 129) were randomized to qHPV vaccine or placebo. The most common adverse event was injection-site pain predominating in the placebo group [the first dose (83.6% vs. 56.1%; p = 0.0001]; the second dose (87.8% vs. 98.4%; p = 0.0001); the third dose (67.7% vs. 91.9%; p = 0.0001). The vaccine did not influence either the viral load of HIV or the levels of CD4. Of those vaccinated, 76% had antibodies to HPV vs. 30.2% of those receiving placebo (p = 0.0001). In the multivariate analysis, Older age was associated with lower HR-HPV infection (RR 0.97; 95% CI 0.96–0.99), and risk factor were viral load of HIV >200 copies/µL (RR 1.42 95% CI 1.17–1.73) and early commencement of sexual activity (RR 1.35; 95% CI 1.001–1.811).ConclusionsThis trial showed significantly higher anti-HR-HPV antibody titres in vaccinated individuals than in unvaccinated controls. There were no serious adverse events attributable to the vaccine. In our cohort, 1 of every 7 patients had HSIL and the prevalence of combined infection by genotypes 16 and 18 was low. This suggests that patients could benefit from receiving qHPV vaccine. Older age was the main protective factor against HR-HPV infection, and non-suppressed HIV viremia was a risk factor.Clinical trial registration: ISRCTN14732216 (http://www.isrctn.com/ISRCTN14732216).

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“…In total, 14 studies reported on the performance of cytology in detecting anal precancers and cancers, including 881 findings of AIN2 or higher and 3706 findings of AIN2 or lower . The distribution of abnormal cytology results in all 14 studies was 12% ASC‐US, 18% LSIL, and 5% HSIL, with prevalence varying significantly by HIV status (Supporting Fig.…”

Section: Resultsmentioning

confidence: 99%

Strategies for screening and early detection of anal cancers: A narrative and systematic review and meta‐analysis of cytology, HPV testing, and other biomarkers

Clarke

Wentzensen

2018

Cancer Cytopathology

110

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Anal cancer incidence and mortality have been increasing over the past decade. Although the incidence in the general population remains low, it is much higher in certain subgroups, including those living with human immunodeficiency virus and men who have sex with men. Approximately 90% of anal squamous cell cancers are caused by infection with carcinogenic human papillomavirus (HPV). Given the common etiology between anal and cervical carcinogenesis, screening for anal cancer has been proposed in certain high-risk populations using strategies adapted from cervical cancer prevention. In this review, the authors discuss important differences in anal and cervical cancer regarding the populations at risk, disease natural history, and clinical procedures and outcomes that need to be considered when evaluating strategies for anal cancer screening. They also performed a systematic review and meta-analysis of the performance of anal cytology, anal HPV testing, and various biomarkers for the detection of anal precancers and cancers. The implications of these performance estimates are summarized in the context of risk-based screening and management of anal precancers, and important research gaps are highlighted that need to be addressed to fully understand the benefits and harms of anal cancer screening. Cancer Cytopathol 2018. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

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Prevalence of Abnormal Anal Cytology and High-Grade Squamous Intraepithelial Lesions Among a Cohort of HIV-Infected Men Who Have Sex With Men

Abstract: The prevalence of high-risk human papillomavirus infection and high-grade squamous intraepithelial lesions is high in our cohort. Physical examination enabled straightforward diagnosis of perianal high-grade squamous intraepithelial lesions and squamous-cell carcinoma in 2 patients.

Cited by 39 publications

References 35 publications

Anal Cancer Screening in Men Who Have Sex With Men in the Multicenter AIDS Cohort Study

Anal Cancer Screening in Men Who Have Sex With Men in the Multicenter AIDS Cohort Study

Safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine in HIV-positive Spanish men who have sex with men (MSM)

Strategies for screening and early detection of anal cancers: A narrative and systematic review and meta‐analysis of cytology, HPV testing, and other biomarkers

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