title: Anal Cancer Screening in Men Who Have Sex With Men in the Multicenter AIDS Cohort Study.
abstract: OBJECTIVE
  To evaluate the prevalence of anal cytology (ACyt) abnormalities among HIV-infected and HIV-uninfected men who have sex with men (MSM).
  
  
  METHODS
  Multicenter cohort study of 723 HIV-infected and 788 HIV-uninfected MSM with ACyt, with a second ACyt collected 2 years later. A referral for high-resolution anoscopy was suggested for abnormal ACyt.
  
  
  METHODS
  ACyt samples were collected using a polyester swab and liquid cytology media and read in a central laboratory.
  
  
  RESULTS
  Prevalence of any abnormal ACyt was 25% in HIV-uninfected MSM and increased to 38%, 41%, and 47% among HIV-infected MSM with current CD4 T-cell counts ≥500, 350-499, and <350 cells/mm (P < 0.001), respectively. Anal HPV16 DNA was also more common in HIV-infected than HIV-uninfected MSM (25% versus 16%, P < 0.001). Abnormal baseline ACyt together with prevalent HPV16 DNA detection was present in only 7% of HIV-uninfected MSM compared to 18% of HIV-infected MSM with current CD4 < 350, P < 0.001. Among HIV-infected men, 56% of the men with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions ASCs-US/LSILs and 81% of men with atypical squamous cells cannot exclude high-grade (ASC-H/)/high-grade squamous intraepithelial lesions (HSIL) had lower grade ACyt findings 18-30 months later ("regressed"). However, 19% of untreated HIV-infected men with ASC-H/HSIL cytology maintained that same grade of cytology in their second test approximately 2 years later, and 15% with ASC-US/LSIL "progressed" to ASC-H/HSIL. Abnormal ACyt had high sensitivity (96%) but low specificity (17%) for biopsy-proven HSIL.
  
  
  CONCLUSIONS
  Prevalence of abnormal ACyt remains elevated in HIV-infected men during the current antiretroviral therapy era.
authors.affiliation: *Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †School of Nursing, University of California, Los Angeles, CA; ‡Department of Pathology, University of California, San Francisco, CA; §Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM; ‖Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC; ¶Department of Infectious Disease, Northwestern University, Chicago, IL; #Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA; **Tricore Reference Laboratories. Albuquerque, NM; and ††Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: DʼSouza
authors.forename: Alicia
authors.initials: A
authors.lastname: Wentz
authors.forename: Dorothy
authors.initials: D
authors.lastname: Wiley
authors.forename: Nisha
authors.initials: N
authors.lastname: Shah
authors.forename: Francine
authors.initials: F
authors.lastname: Barrington
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Darragh
authors.forename: Nancy
authors.initials: N
authors.lastname: Joste
authors.forename: Michael
authors.initials: M
authors.lastname: Plankey
authors.forename: Susheel
authors.initials: S
authors.lastname: Reddy
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Breen
authors.forename: Stephen
authors.initials: S
authors.lastname: Young
authors.forename: Ross D
authors.initials: RD
authors.lastname: Cranston
mesh_terms: D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology; D015331:Cohort Studies; D003581:Cytodiagnosis; D055088:Early Detection of Cancer; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology; D015995:Prevalence; D011351:Proctoscopy; D014481:United States / Q000453:epidemiology