Diagnostic methods for prevention of anal cancer and characteristics of anal lesions caused by HPV in men with HIV/AIDS

Abstract

Abnormalities found with anuscopy under colposcopic vision, anal cytology and anal biopsy were evaluated in 21 men with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) at the Federal University of Pernambuco Hospital in Brazil. Mean age was 38.4 ± 6.0 years, and mean time of HIV infection was 8.3 ± 5.1 years; 95.2% of the patients had been on highly active antiretroviral therapy (HAART) for an average of 6.6 ± 4.5 years. Mean CD4+ cell count was 482.2 ± 173.75 cells/mm 3 , and 80.9% presented a HIV viral load of < 5,000 copies/mL. Reported sexual preference was 52.4% homosexuals, 28.6% bisexuals, and 19.0%heterosexuals; 81% reported having had receptive anal intercourse and 61.9% reported more than 10 sexual partners of the same sex. Results of anuscopy under colposcopic vision revealed 17 (81.0%) low-grade lesions and/or condylomata or micropapillae and four (19.0%) high-grade lesions with or without condylomata. Among the 21 anal cytology examinations, seven (33.3%) revealed low-grade squamous intraepithelial lesions (LSIL); three (14.3%) presented atypical squamous cells of undetermined significance (ASCUS) and 11 (52.4%) were normal. Seventeen patients were submitted to anal biopsy with the following findings: three patients (17.6%) with normal epithelium, one (5.9%) with infection by HPV, three (17.6%) with condylomatas, two (11.8%) with AIN 1, four (23.6%) with AIN 2, three (17.6%) with AIN 3, and one (5.9%) with PAIN 2. Anuscopy under colposcopic vision was found to be useful for detecting anal lesions and for guiding anal biopsies. Anal cytology was less useful, as it underestimated the frequency of lesions.

A comparative study between conventional and liquid‐based cytology in screening for anal intraepithelial lesions in HIV‐positive patients

“…Although this is generally the case, some studies report opposing results. Pereira et al found that anoscopy was more reliable than cytology in identifying anal lesions . Sensitivity and specificity rates of anoscopy vary greatly in the literature, since this is still a very subjective, as well as user, equipment and other‐comorbidity‐dependent test .…”

Prevalence of abnormal anal cytology in women infected with HIV

“…Arain et al [2005] suggest that patients with atypical squamous cells of undetermined significance or a more severe diagnosis should be evaluated with high‐resolution anoscopy and biopsy. Although Pereira et al [2008] criticized blind anal cytology collection and instead recommend anoscopy under colposcopic visualization, their study only included 21 patients [Pereira et al, 2008]. On the other hand, Vajdic et al [2005] showed that blind cytology smears were superior to anoscopy‐guided smears for screening purposes (15 vs. 27 cases, P = 0.001) in 151 MSM.…”

The Need for Anal Dysplasia Screening and Treatment Programs for HIV-Infected Men Who Have Sex With Men

“…The more controversial issue regards how often anal Pap results are negative when anal dysplasia is actually present. Two recent studies in which both anal Pap tests and HRA with biopsy were performed initially indicated that a significant percentage of HIVinfected MSM had anal dysplasia on biopsy despite having negative anal Pap test results Pereira, de Lacerda, & do Rego Barros, 2008). However, it has been argued that this is also the case with cervical dysplasia screening and that, as long as patients undergo regular anal Pap testing, most cases of anal dysplasia will eventually be discovered (Park & Palefsky, 2010).…”

“…Given this concern and the fact that anal dysplasia rates are so high among HIV-infected MSM, some experts have called for HRA with biopsy to be the initial screening method of choice, dispensing with anal Pap testing (Pereira et al, 2008;Salit et al, 2010). This approach assumes that HRA with biopsy is much better at detecting actual dysplasia than anal Pap, and thus lesions missed by anal Pap would be detected with HRA.…”