You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

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

Goldstone, Stephen E. M.D.1; Moshier, Erin M.S.2

Diseases of the Colon & Rectum:
doi: 10.1007/DCR.0b013e3181e10842
Original Contribution
Abstract

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.

Author Information

1 Department of Surgery, The Mount Sinai School of Medicine, New York, New York

2 Department of Preventive Medicine, The Mount Sinai School of Medicine, New York, New York

Support: Participation by Chinedum Enyinna was supported by the Mount Sinai Summer Research Fellowship.

Financial Disclosure: Dr Goldstone received funding from Qiagen, Gaithersburg, MD, to cover in part the costs of statistical analysis that E.M. performed at The Mount Sinai School of Medicine.

Correspondence: Stephen E. Goldstone, M.D., 420 West 23rd St, New York, NY 10011. E-mail: segmd@prodigy.net

© The ASCRS 2010