Screening for Anal Dysplasia in HIV-Infected Men Who Have Sex with Men By Anal Cytology, Human Papillomavirus Testing and Anoscopy

The incidence of anal cancer in HIV-infected men who have sex with men (MSM) is increasing and screening is advo-cated. In a cross-sectional study anal cytology specimens from 58 HIV-infected MSM were analyzed for adequacy, cy-tology and HPV DNA testing results and compared to findings on anoscopy. The adequacy of cytology specimens was high. In 34 (63%) of anal swab samples any grade of dysplasia was observed compared to 41 (71%) of biopsy speci-mens. The cytology specimens revealed high-grade dysplasia in 4 (7%) compared to 29 (50%) of biopsy specimens. The prevalence of high-risk HPV types was 90% by using the SPF10 PCR and 81% by using the Hybrid Capture II assay. Because of the high HPV prevalence, HPV DNA testing alone is not a suitable diagnostic screening tool for detecting anogenital lesions in this specific MSM population. Screening should include both anal cytology and anoscopy.