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.
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: firstname.lastname@example.org