Anal cytology as a screening tool for early detection of anal dysplasia in HIV-infected women.
OBJECTIVE
HIV-infected patients show a high rate of anal dysplasia and anal carcinoma but there is no gold standard for early detection. Therefore, the objectives of this prospective study were: a) evaluation of an anal screening using anal/perianal cytology; b) in case of a positive result to investigate its relation to immune status, clinical symptoms of HIV infection and antiretroviral therapy.


METHODS
In every HIV-infected woman visiting our gynaecological outpatient clinic, an anal and perianal swab for anal cytology was taken. One experienced cytologist examined all specimens. Relevant details of the HIV-related history such as CDC classification, CD4 count, viral load, actual antiretroviral therapy etc. were documented.


RESULTS
Altogether, 104 HIV-infected women were enrolled on this study. The results of 13 (13.5%) anal cytologies were classified as suspicious for low-grade or high-grade anal dysplasia and 6 of these were confirmed in an anal biopsy. A total of 9 out of 13 also had a cervical dysplasia and 12 were positive for high-risk HPV at the cervix. Ten of these women had already experienced clinical symptoms of their HIV infection and 8 showed a nadir of the CD4 count below 200 cells/microl. All but one took a highly active antiretroviral therapy.


CONCLUSIONS
In this pilot study, anal screening using anal cytology showed 13.5% suspected anal dysplasia in HIV-infected women. All performed biopsies revealed the presence of a high-grade anal lesion. The majority of these women already had an advanced disease and/or immune defect related to their HIV infection. In summary, we found anal cytology to be a useful tool to early detect anal dysplasia of high-risk patients such as HIV-infected women. How far this screening method contributes to the prevention of anal cancer has to be evaluated in further investigations.
Gingelmaier
Andrea
A
Department of Obstetrics and Gynecology, Downtown Campus, Ludwig Maximilians University, Munich, Germany. andrea.gingelmaier@med.uni-muenchen.de
Weissenbacher
Tobias
T
Kost
Bernd
B
Kaestner
Ralph
R
Sovric
Milena
M
Mylonas
Ioannis
I
Friese
Klaus
K
Bergauer
Florian
F
D000328:Adult; D001003:Anal Canal / Q000473:pathology* / Q000821:virology; D001004:Anus Diseases / Q000150:complications / Q000175:diagnosis* / Q000821:virology*; D001005:Anus Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D001706:Biopsy; D015331:Cohort Studies; D003584:Cytological Techniques / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000821:virology*; D006801:Humans; D007107:Immune System; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis / Q000821:virology; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000175:diagnosis / Q000821:virology