Anal and Pharyngeal Screening Cytology and Human Papilloma Virus Testing in HIV-Infected Men Who Have Sex with Men
D Badia, N Tallada, S Vilar, J Hernandez, M Alberola, C Dinares, C Iglesias, F Marginean, A Solsona, S Ramon y Cajal. Vall D'Hebron Universitary Hospital, Barcelona, Spain
Background: The incidence of anal squamous dysplasia and cancer in men HIV-infected who have sex with men is increasing. Anal cytology and HPV testing is proposed as a tool for diagnosing and selecting patients for further anoscopy. Moreover, limited data is available on oral and anal associated diseases in HIV positive patients. The presence of HPV in pharyngeal and anal samples remains to be determined, despite oral cancer associated HPV is known.
Design: Our aim is to correlate results of anal and pharyngeal screening cytology with HPV testing and subtyping in HIV-infected men who have sex with men to establish the significance in anal and oral HPV associated lesions.We collected 94 cases of anal and pharyngeal liquid cytology (Thin-Prep) from 47 HIV-infected men.Cytology samples were classified according to the Bethesda criteria. HPV DNA detection was performed by PCR amplification (HPV Clinical Arrays Genomica). Subtypes were classified according to low (LR), high (HR), potentially high and indetermined risk category.
Results: Cytology: 69 (73'4%) with negative results; 25 (26'6%) abnormal smears: 23 anal samples- 11 (AIS/ASCUS),11 LSIL and 1 HSIL; 2 pharyngeal samples presented AIS/ASCUS.HPV DNA was detected in 61 cases (64'9%);42 anal and 19 pharyngeal (22 with single subtype and 39 multiple infection.The most common were HR-HPV:16(13 cases), 59(12 cases), 35(8 cases) and 52(7 cases). Potential HR 1, indeterminate-risk 3 and LR 4 cases.Multiple infection (39 cases) detected HR subtypes in all samples.HPV was present in 18 cases in both anal and pharyngeal samples. Cytology/HPV Concordance between abnormal cytology and HPV was present in 24 cases (22 anal and 2 pharyngeal). In pharyngeal positive cases cytology and HPV was present with same HPV in anal sample (52,56).HPV59 was the most frequent subtype in pharyngeal cases. In anal samples predominant multiple infections (36 cases) of HR-HPV were present and 16 was the most prevalent.
Conclusions: Anal predominant multiple subtype infections presented a HR-HPV, therefore it is suggested a more accurate cytologic follow-up and high-resolution anoscopy for this patients.HPV59 is prevalent in pharyngeal samples, although nasopharynx cancer is related to HPV16. Pharyngeal cytology has even lower sensitivity than anal.HPV detection adjuncts to anal and pharyngeal cytology can help to select high risk patients.
Tuesday, March 23, 2010 9:30 AM
Poster Session III # 88, Tuesday Morning