Anal Cancer Screening in Men Who Have Sex with Men in the Multicenter AIDS Cohort Study.
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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.ACyt samples were collected using a polyester swab and liquid cytology media, and read in a central laboratory.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 (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.Prevalence of abnormal ACyt remains elevated in HIV-infected men during the current ART era.
