title: Anal cancer screening in HIV-infected patients: is it time to screen them all?
abstract: BACKGROUND
  Annual screening for anal cancer is recommended only for HIV patients at increased risk: men who have sex with men, individuals with a history of anogenital warts, and women with cervical dysplasia.
  
  
  OBJECTIVE
  The aim of this study was to examine the screening outcomes between HIV populations with and without these risk factors.
  
  
  METHODS
  We reviewed the records of all HIV patients referred for anal cytology and high-resolution anoscopy from June 2009 to June 2010. Patients were stratified into an increased-risk group or a standard-risk group.
  
  
  RESULTS
  Of the 329 evaluable patients, 285 (89.8% men, 10.2% women, mean age 46 ± 10 years) were classified to the increased-risk group, whereas 44 (72.7% men, 27.3% women, mean age 52 ± 8 years) were included in the standard-risk group. Male sex, white race, sexual orientation, past and current receptive anal intercourse, noncompliance with condom use, and absence of a new sexual partner were significantly different in the increased-risk group in comparison with the standard-risk group. In the increased-risk group, 187 (66.5%) patients had biopsy-proven dysplasia of which 118 (42.0%) had high-grade disease. In the standard-risk group, 15 (34.9%) patients had biopsy-proven dysplasia of which 7 (16.3%) had high-grade disease. Cytology detected biopsy-confirmed high-grade dysplasia only in 23 of 118 (19.5%) patients in the increased-risk group and in 2 of 7 (28.6%) patients in the standard-risk group. Kappa agreement in detecting high-grade disease was low for both increased-risk and standard-risk groups: 0.16 (95% CI 0.07-0.23) and 0.40 (95% CI 0.02-0.40).
  
  
  CONCLUSIONS
  Our study is a chart-based retrospective review of data with a small female population. Histology reports came from 2 different laboratories.
  
  
  CONCLUSIONS
  High-grade anal dysplasia was prevalent even among HIV patients who only have standard risk factors. Anal cytology and high-resolution anoscopy have poor agreement. We suggest considering annual screening by using high-resolution anoscopy in addition to cytology for all HIV patients regardless of risk factors.
authors.affiliation: Department of Medicine, Rochester General Hospital, Rochester, New York, USA. alexander.mallari@rochestergeneral.org
authors.forename: Alexander O
authors.initials: AO
authors.lastname: Mallari
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Schwartz
authors.forename: Amneris E
authors.initials: AE
authors.lastname: Luque
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Polashenski
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Rauh
authors.forename: Roberto B
authors.initials: RB
authors.lastname: Corales
mesh_terms: D001005:Anus Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D016009:Chi-Square Distribution; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric