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Article << Previous     |     Next >>   Contents Vol 10(1)

Anal cytological abnormalities are poor predictors of high-grade intraepithelial neoplasia amongst HIV-positive men who have sex with men

Leon P. Botes A B, Sarah Pett B C, Andrew Carr B, Debbie Marriott B, David A. Cooper B C, Gail Matthews B C, Sonia Carbone D, Nirmala Kumaradevan D, Leo McHugh A and Richard J. Hillman A B C E

A Western Sydney Sexual Health Centre, Parramatta, NSW 2150, Australia.
B Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, NSW 2010, Australia.
C The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
D SydPath Laboratories, St Vincent’s Hospital, Sydney, NSW 2010, Australia.
E Corresponding author. Email: richard.hillman@sydney.edu.au

Sexual Health 10(1) 9-17 http://dx.doi.org/10.1071/SH11135
Submitted: 21 September 2011  Accepted: 8 May 2012   Published: 21 December 2012

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Background: Although anal squamous cell carcinomas (ASCC) are rare in the general community, rates of ASCC among HIV-positive men who have sex with men (MSM) approach those of major cancers in the general community, such as colorectal and lung cancers. Anal cytology and high-resolution anoscopy (HRA) have been proposed as methods for the diagnosis of high-grade anal intraepithelial neoplasia (HGAIN), the precursor of ASCC. To determine the prevalence of anal disease among HIV-positive MSM, we investigated anal cytological and histological findings in men from a large HIV clinic in Sydney, Australia. Methods: This was a single-centre study conducted between October 2008 and January 2010. Participants self-collected cytology specimens, and those yielding abnormal cytology results of atypical cells of undetermined significance, atypical cells of undetermined significance – possibly high-grade (ASC-H) and high-grade squamous intraepithelial lesions (HSIL) were offered HRA. In addition, of those yielding low-grade squamous intraepithelial lesions results, a systematically selected group (25%) were offered HRA. Results: Of the 1339 HIV-positive MSM who attended the clinic during the study period, 291 (31.8%) were finally included in the study, 262 yielded technically satisfactory cytological results and 101 (36.7%) participants underwent HRA. HGAIN was identified in 55 (54.5%) of the 101 men undergoing HRA. HGAIN was diagnosed in 28 (52.7%) without cytological ASC-H or HSIL results. Conclusions: Despite the poor correlation between anal cytological and histological findings, high levels of HGAIN were identified in HIV-positive MSM attending this clinical service.

Additional keywords: anal squamous cell carcinoma, high-grade squamous intraepithelial lesion, high-resolution anoscopy.


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