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J Acquir Immune Defic Syndr. 2016 Apr 15;71(5):570-6. doi: 10.1097/QAI.0000000000000910.

Anal Cancer Screening in Men Who Have Sex With Men in the Multicenter AIDS Cohort Study.

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*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.



To evaluate the prevalence of anal cytology (ACyt) abnormalities among HIV-infected and HIV-uninfected men who have sex with men (MSM).


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.


ACyt samples were collected using a polyester swab and liquid cytology media and read in a central laboratory.


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.


Prevalence of abnormal ACyt remains elevated in HIV-infected men during the current antiretroviral therapy era.

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