title: Oncogenic human papillomavirus is not helpful for cytology screening of the precursor lesions of anal cancers in Taiwanese men who are infected with human immunodeficiency virus.
abstract: BACKGROUND
  Homosexual men infected with human immunodeficiency virus (HIV) are at increased risk of developing anal cancer. The aim of this study was to assess the clinical sensitivity of anal cytology analysis and oncogenic human papillomavirus (HPV) detection for predicting histological anal intraepithelial neoplasia.
  
  
  METHODS
  Between March 2011 and December 2013, we enrolled 196 HIV-positive men in Taoyuan General Hospital, Taiwan. We analyzed the results of thin-preparation anal Pap smears, HPV genotyping, and histology of anoscopic biopsy samples.
  
  
  RESULTS
  The mean age (±standard deviation) was 31.43 (±8.74) years. The proportion (95 % confidence interval) with abnormal thin-preparation anal cytology was 36.2 % (29.8-43.2 %): 16.8 % (12.2-22.7 %) atypical squamous cells of undetermined significance, 14.8 % (10.5-20.4 %) low-grade squamous intraepithelial lesions, and 4.6 % (2.4-8.5 %) high-grade squamous intraepithelial lesions. At least one HPV genotype was detected in 90.8 % of subjects, and the mean number of HPV infection types was 4.41 (±3.24).The frequency of histological high-grade anal intraepithelial lesions was 7.14 % (95 % confidence interval 4.3-11.6 %). Anal cytology yielding atypical squamous cells of undetermined significance or higher grades resulted in a sensitivity of 64.3 %, specificity of 65.9 %, positive predictive value of 12.7 %, and negative predictive value of 96 %. Using both oncogenic HPV and cytology did not provide better performance.
  
  
  CONCLUSIONS
  Anal cytology yielding atypical squamous cells of undetermined significance or higher grades could detect two-thirds of high-grade anal intraepithelial neoplasias in HIV-infected men and should be promoted for anal cancer prevention.
authors.affiliation: School of Public Health, College of Public Health and Nutrition, Taipei Medical University, No. 250 Wu-Hsing St, Taipei, Taiwan.|Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
authors.forename: Shu-Hsing
authors.initials: SH
authors.lastname: Cheng
authors.affiliation: Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
authors.forename: Chi-Chao
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Department of Pathology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
authors.forename: Shih-Lung
authors.initials: SL
authors.lastname: Chang
authors.affiliation: School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei, Taiwan.|Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Fang-Yeh
authors.initials: FY
authors.lastname: Chu
authors.affiliation: School of Public Health, College of Public Health and Nutrition, Taipei Medical University, No. 250 Wu-Hsing St, Taipei, Taiwan. ymhsueh@tmu.edu.tw.|Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. ymhsueh@tmu.edu.tw.
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Hsueh
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000150:complications / Q000473:pathology* / Q000821:virology; D003581:Cytodiagnosis; D055088:Early Detection of Cancer; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications / Q000473:pathology* / Q000821:virology; D011230:Precancerous Conditions / Q000150:complications / Q000473:pathology* / Q000821:virology; D013624:Taiwan; D055815:Young Adult
keywords: Anal intraepithelial neoplasia; Human immunodeficiency virus (HIV); Human papillomavirus (HPV); Men who have sex with men; Squamous intraepithelial lesion