Detection of Oncogenic Human Papillomavirus Impacts Anal Screening Guidelines in Men Who Have Sex With Men

• Published in: Diseases of the colon & rectum Vol. 53; no. 8; pp. 1135 - 1142
• Main Authors: Goldstone, Stephen E., Moshier, Erin
• Format: Journal Article
• Language: English
• Published: Hagerstown, MDc The ASCRS 01.08.2010; Lippincott Williams & Wilkins
• Subjects: Adult; Anal Canal - pathology; Anal Canal - virology; Anus Neoplasms - diagnosis; Anus Neoplasms - epidemiology; Anus Neoplasms - virology; Biological and medical sciences; Colonoscopy; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; HIV Seropositivity; Homosexuality, Male; Humans; Incidence; Male; Mass Screening - standards; Medical sciences; Papillomaviridae - isolation & purification; Papillomavirus Infections - diagnosis; Papillomavirus Infections - epidemiology; Papillomavirus Infections - virology; Practice Guidelines as Topic; Precancerous Conditions; Predictive Value of Tests; Retrospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumor Virus Infections - diagnosis; Tumor Virus Infections - epidemiology; Tumor Virus Infections - virology; Tumors; United States - epidemiology; United States; Dysplasia; Homosexuality; Anal cancer; Men who have sex with men; Papovaviridae; Malignant tumor; Medical screening; Papillomavirus; Virus; Human papillomavirus; Hybrid-capture; Anus; Anal dysplasia; Gastroenterology; Digestive diseases; Intestinal disease; Anorectal disease; Cancer
• ISSN: 0012-3706; 1530-0358; 1530-0358
• DOI: 10.1007/DCR.0b013e3181e10842

PURPOSE:It has been shown that testing for oncogenic human papillomavirus (HPV+) improves the sensitivity of cytologic diagnosis of atypical cells of undetermined significance in the cervix and anus, reducing the number of patients requiring colposcopy or high-resolution anoscopy. Some recommend that men who have sex with men with any abnormal cytology undergo high-resolution anoscopy. We endeavored to determine whether HPV testing could predict future high-grade dysplasia (high-grade squamous intraepithelial lesions) and modify screening internals. METHODS:This investigation was conducted via a retrospective chart review of subjects with atypical cells of undetermined significance anal cytology, high-resolution anoscopy, and HPV testing. Records were abstracted for prior and subsequent screenings. RESULTS:Four hundred men who have sex with men (285 HIV−) underwent 2224 screenings. Of 224 subjects monitored for >2 years, the hazard ratio for developing high-grade dysplasia was 77% less for men who have sex with men who never had oncogenic HPV (HPV−) vs those who stayed HPV+ (P < .013). The hazard ratio for high-grade dysplasia in those who were HPV− vs those who became HPV− was not different. Risk of high-grade dysplasia was 28% within 6 months of becoming HPV+. The 3-year high-grade dysplasia risk was 15% and 54% for HPV− vs HPV+ subjects (P = .0006). Frequency of high-grade dysplasia in subjects who remained HPV− with predominantly atypical cells of undetermined significance cytology for 1, 2, or 3 years was 2%, 0% and 0% and was 17%, 0%, and 0% in HIV+ subjects. Kaplan-Meier analysis for HIV− subjects with HPV− predominantly atypical cells of undetermined significance cytology for 1 year showed <5% incidence of high-grade dysplasia at 4 years. CONCLUSIONS:Change in HPV status can predict the risk of high-grade dysplasia. Subjects with predominantly HPV− atypical cells of undetermined significance cytology for 2 years have a decreased risk of high-grade dysplasia. HPV testing when screening for anal dysplasia could alter screening parameters.