title: Anal cytological abnormalities are poor predictors of high-grade intraepithelial neoplasia amongst HIV-positive men who have sex with men.
abstract: BACKGROUND
  Although anal squamous cell carcinomas (ASCC) are rare in the general community, rates of ASCC among HIV-positive men who have sex with men (MSM) approach those of major cancers in the general community, such as colorectal and lung cancers. Anal cytology and high-resolution anoscopy (HRA) have been proposed as methods for the diagnosis of high-grade anal intraepithelial neoplasia (HGAIN), the precursor of ASCC. To determine the prevalence of anal disease among HIV-positive MSM, we investigated anal cytological and histological findings in men from a large HIV clinic in Sydney, Australia.
  
  
  METHODS
  This was a single-centre study conducted between October 2008 and January 2010. Participants self-collected cytology specimens, and those yielding abnormal cytology results of atypical cells of undetermined significance, atypical cells of undetermined significance - possibly high-grade (ASC-H) and high-grade squamous intraepithelial lesions (HSIL) were offered HRA. In addition, of those yielding low-grade squamous intraepithelial lesions results, a systematically selected group (25%) were offered HRA.
  
  
  RESULTS
  Of the 1339 HIV-positive MSM who attended the clinic during the study period, 291 (31.8%) were finally included in the study, 262 yielded technically satisfactory cytological results and 101 (36.7%) participants underwent HRA. HGAIN was identified in 55 (54.5%) of the 101 men undergoing HRA. HGAIN was diagnosed in 28 (52.7%) without cytological ASC-H or HSIL results.
  
  
  CONCLUSIONS
  Despite the poor correlation between anal cytological and histological findings, high levels of HGAIN were identified in HIV-positive MSM attending this clinical service.
authors.affiliation: Western Sydney Sexual Health Centre, Parramatta, NSW, Australia.
authors.forename: Leon P
authors.initials: LP
authors.lastname: Botes
authors.forename: Sarah
authors.initials: S
authors.lastname: Pett
authors.forename: Andrew
authors.initials: A
authors.lastname: Carr
authors.forename: Debbie
authors.initials: D
authors.lastname: Marriott
authors.forename: David A
authors.initials: DA
authors.lastname: Cooper
authors.forename: Gail
authors.initials: G
authors.lastname: Matthews
authors.forename: Sonia
authors.initials: S
authors.lastname: Carbone
authors.forename: Nirmala
authors.initials: N
authors.lastname: Kumaradevan
authors.forename: Leo
authors.initials: L
authors.lastname: McHugh
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hillman
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology*; D001005:Anus Neoplasms / Q000453:epidemiology / Q000473:pathology*; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology*; D003584:Cytological Techniques; D006679:HIV Seropositivity / Q000453:epidemiology / Q000473:pathology*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*; D011237:Predictive Value of Tests