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

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

来源：JAIDS: Journal of Acquired Immune Deficiency Syndromes , 2016, 71(5): 570-576.

DOI：10.1097/QAI.0000000000000910

• anal cancer
• HIV
• MSM
• HPV
• screening
• MACS
• anal cytology
• anal dysplasia

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.

• 出版日期2016-4-15
• 单位西北大学