title: The role of polymerase chain reaction of high-risk human papilloma virus in the screening of high-grade squamous intraepithelial lesions in the anal mucosa of human immunodeficiency virus-positive males having sex with males.
abstract: OBJECTIVE
  To evaluate the advantages of cytology and PCR of high-risk human papilloma virus (PCR HR-HPV) infection in biopsy-derived diagnosis of high-grade squamous intraepithelial lesions (HSIL = AIN2/AIN3) in HIV-positive men having sex with men (MSM).
  
  
  METHODS
  This is a single-centered study conducted between May 2010 and May 2014 in patients (n = 201, mean age 37 years) recruited from our outpatient clinic. Samples of anal canal mucosa were taken into liquid medium for PCR HPV analysis and for cytology. Anoscopy was performed for histology evaluation.
  
  
  RESULTS
  Anoscopy showed 33.8% were normal, 47.8% low-grade squamous intraepithelial lesions (LSIL), and 18.4% HSIL; 80.2% had HR-HPV. PCR of HR-HPV had greater sensitivity than did cytology (88.8% vs. 75.7%) in HSIL screening, with similar positive (PPV) and negative predictive value (NPV) of 20.3 vs. 22.9 and 89.7 vs. 88.1, respectively. Combining both tests increased the sensitivity and NPV of HSIL diagnosis to 100%. Correlation of cytology vs. histology was, generally, very low and PCR of HR-HPV vs. histology was non-existent (<0.2) or low (<0.4). Area under the receiver operating characteristics (AUROC) curve analysis of cytology and PCR HR-HPV for the diagnosis of HSIL was poor (<0.6). Multivariate regression analysis showed protective factors against HSIL were: viral suppression (OR: 0.312; 95%CI: 0.099-0.984), and/or syphilis infection (OR: 0.193; 95%CI: 0.045-0.827). HSIL risk was associated with HPV-68 genotype (OR: 20.1; 95%CI: 2.04-197.82).
  
  
  CONCLUSIONS
  When cytology and PCR HR-HPV findings are normal, the diagnosis of pre-malignant HSIL can be reliably ruled-out in HIV suppression with treatment protects against the appearance of HSIL [corrected].
authors: Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain.
authors: Carmen
authors: C
authors: Hidalgo-Tenorio
authors: Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain.
authors: Mar
authors: M
authors: Rivero-Rodriguez
authors: Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain.
authors: Concepción
authors: C
authors: Gil-Anguita
authors: Pathology Service, University Hospital Virgen de las Nieves, Granada, Spain.
authors: Javier
authors: J
authors: Esquivias
authors: Pathology Service, University Hospital Virgen de las Nieves, Granada, Spain.
authors: Rodrigo
authors: R
authors: López-Castro
authors: Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain.
authors: Jessica
authors: J
authors: Ramírez-Taboada
authors: Gastroenterology Service, University Hospital Virgen de las Nieves, Granada, Spain.
authors: Mercedes López
authors: ML
authors: de Hierro
authors: Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain.
authors: Miguel A
authors: MA
authors: López-Ruiz
authors: Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain.
authors: R Javier
authors: RJ
authors: Martínez
authors: Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain.
authors: Juan P
authors: JP
authors: Llaño
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology* / Q000821:virology; D001005:Anus Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D003430:Cross-Sectional Studies; D003581:Cytodiagnosis; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006679:HIV Seropositivity; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D009092:Mucous Membrane / Q000473:pathology / Q000821:virology; D027383:Papillomaviridae / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology
chemical_list: D004279:DNA, Viral