Prevalence of High-Risk Human Papillomavirus (HPV) in HIV-Positive Males Diagnosed with ASC-US in Anal Cytology Specimens
J Yuan, MA Friedlander, O Lin, NM Savage, NC Messias, P Ramalingam, MD Reid-Nicholson. Medical College of Georgia, Augusta, GA; Memorial Sloan-Kettering Cancer Center, New York, NY
Background: Human Immunodeficiency Virus (HIV)-positive men have an increased incidence of anal carcinoma and Human papillomavirus (HPV)-associated intraepithelial squamous anal lesions on anal cytology specimens. While HPV testing is extremely useful in triaging atypical squamous cells (ASC) of undetermined significance (ASC-US) in cervico-vaginal pap smears and reduces the number of unnecessary colposcopies, very little information exists regarding the prevalence of high-risk HPV (HR-HPV) in HIV-positive males with ASC-US on anal cytology. This study sought to determine if HPV screening is useful in triaging these patients by estimating the prevalence of HR-HPV in this cohort.
Design: We identified 43 HIV-positive males with an ASC-US result on anal cytology. Six patients were excluded because the HPV test results were equivocal or were not performed. A total of 37 specimens with corresponding HPV results were analyzed. All specimens were Thin Prep™-based and Papanicolaou-stained. HR-HPV testing was performed by hybrid capture assay (Digene®).
Results: Patients ranged in age from 25– 63 (mean=50 years). Overall prevalence of HR-HPV in the HIV-positive males was 62% (23/37). Sixteen of 23 patients in whom HR-HPV was detected had follow-up, either with cytology or biopsies. Eight of 16 patients with subsequent cytology specimens were diagnosed as follows; ASC-US (n=4), ASC-Cannot exclude a high-grade lesion (ASC-H) (n=1), low-grade squamous intraepithelial lesion (LSIL) (n=1) and high-grade squamous intraepithelial lesions (HSIL) (n=2). The remaining 8 patients had subsequent anal biopsies that were diagnosed as negative(n=4) and anal intraepithelial neoplasia (AIN) 1 (n=1), AIN 2 (n=2) and AIN 3 (n=1). Therefore, half of the patients with histological correlation showed the presence of AIN. Six of the 14 (43%) HPV-negative patients had follow-up, either with cytology or biopsies. Five of the 6 patients had subsequent cytology specimens that were diagnosed as follows; negative (n=4) and LSIL (n=1). The sixth patient had a subsequent anal biopsy showing AIN 1.
Conclusions: Anal cytology specimens containing HR-HPV are highly associated with AIN, 25% of which are high-grade on subsequent cytology/biopsy follow-up. HPV testing has a potential role in the triage or management of these patients and can reduce the number of unnecessary anoscopies performed.
Tuesday, March 23, 2010 9:30 AM
Poster Session III # 86, Tuesday Morning