Human papillomavirus status, anal cytology and histopathological outcome in HIV-positive patients.
BACKGROUND
Human papillomavirus (HPV) are responsible for a broad spectrum of mucocutaneous infections and may cause squamous cell carcinoma following long-standing infection . Oncogenic HPV, most commonly HPV 16, are detectable in over 90% of cervical intraepithelial neoplasia and anal intraepithelial neoplasia (AIN). Human immunodeficiency virus (HIV) infection is strongly associated with a higher prevalence of chronic HPV infection, a higher incidence of AIN and an increased risk for anal cancer (AC). In September 2013, guidelines concerning prevention, screening and treatment of AIN for patients affected by HIV were issued by the German AIDS society.


OBJECTIVE
In order to validate the suggested screening procedure, we analysed data from 123 male and female patients with HIV infection that regularly present in our outpatient clinic.


METHODS
Anal cytology, HPV typing and high-resolution anoscopy (HRA) were performed.


RESULTS
Our results show that screening by anal cytology only identifies a minority of patients with high grade AIN (AIN 3) histology. Patients with normal cytology (NILM, cytology graded negative for intraepithelial lesion or malignancy; n = 5, 29.4%), atypical squamous cells of undetermined significance (ASCUS; n = 5, 71.4%) and low grade squamous intraepithelial lesion (LSIL; n = 8, 44.5%) showed highly dysplastic lesions (AIN 2 and 3) in the histological workup more frequently than expected. Additionally, high-grade squamous intraepithelial lesion (HSIL) was strongly associated with detection of high-risk oncogenic HPV.


CONCLUSIONS
Anal cytology as the solitary screening tool for anal cancer fails to detect anal dysplasia in a considerable number of patients. Additionally, HPV typing and possibly further biomarkers might be applied to identify those patients with a higher risk of developing anal carcinoma, in order to monitor them more closely or directly transfer them to HRA.
Department of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany.
A
A
Dietrich
Department of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany.
C
C
Hermans
Department of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany.
M V
MV
Heppt
Department of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany.
T
T
Ruzicka
Department of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany.
J
J
Schauber
Department of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany.
M
M
Reinholz
D000328:Adult; D001003:Anal Canal / Q000473:pathology*; D001005:Anus Neoplasms / Q000473:pathology* / Q000821:virology; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D002278:Carcinoma in Situ / Q000473:pathology* / Q000821:virology; D003581:Cytodiagnosis; D055088:Early Detection of Cancer / Q000379:methods; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005858:Germany; D006679:HIV Seropositivity / Q000150:complications* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification; D030361:Papillomavirus Infections / Q000150:complications* / Q000821:virology; D017410:Practice Guidelines as Topic