title: The Addition of High-Risk HPV Testing to Anal Cytology Increases the Identification of Anal Dysplasia in HIV-Infected Patients.
abstract: BACKGROUND
  Anal dysplasia (AD) is prevalent in HIV-infected patients. Screening for AD is recommended for high-risk groups, including HIV-infected patients. We evaluated screening algorithms for AD using cytology, high-risk human papillomavirus (HRH) testing, or both.
  
  
  METHODS
  HIV-infected patients were offered AD screening by both anal cytology and PCR-based detection of HRH. Patients with abnormal cytology (AC) or HRH genotypes were referred to the same oncologic surgeon for high-resolution anoscopy (HRA).
  
  
  RESULTS
  Ninety patients underwent screening (84% men who have sex with men). Forty-four patients (52.6%) had abnormal screens (31.5% AC, 46% HRH). Twenty-six patients with AC and/or positive HRH had HRA. AC and nadir CD4+ cell count of < 200 cells/mm3 were predictors of abnormal histology on HRA by univariate analysis (OR 4.5 and 2.5, respectively). Using a log-linear model, we estimated that for every 49 cases with two normal screening tests, one case of AD would be missed. Conclusions: Universal screening for AD in an HIV+ population yielded a high percentage of abnormal findings. Addition of HRH to cytology screening increased positive screens by 24%. Larger studies are needed to determine the ideal screening method.
authors.forename: Paul
authors.initials: P
authors.lastname: Anthony
authors.forename: Richard
authors.initials: R
authors.lastname: Feinn
authors.forename: Bruce
authors.initials: B
authors.lastname: Brenner
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Dieckhaus
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Chirch
mesh_terms: D000328:Adult; D000368:Aged; D052685:Alphapapillomavirus / Q000235:genetics*; D001003:Anal Canal / Q000473:pathology* / Q000821:virology; D001004:Anus Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D003237:Connecticut / Q000453:epidemiology; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D004279:DNA, Viral