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Abnormal anal cytology related to high-risk HPV infection in HIV-infected Australians.
  1. Jonathan S Anderson (jstca{at}bigpond.com)
  1. Carlton Clinic, Australia
    1. Jennifer Hoy (jennifer.hoy{at}med.monash.edu.au)
    1. Alfred Hospital,Monash University, Australia
      1. Richard Hillman (rhil8201{at}mail.usyd.edu.au)
      1. STI Research Centre,Sydney University, Australia
        1. Charmaine Gittleson (charmaine.gittleson{at}csl.com.au)
        1. CSL Ltd, Australia
          1. Gunter Hartel (gunter.hartel{at}csl.com.au)
          1. CSL Ltd, Australia
            1. Gabriele Medley (gmedley{at}bigpond.com)
            1. Melbourne Pathology, Australia
              1. Russell Basser (russell.basser{at}csl.com.au)
              1. CSL Ltd, Australia

                Abstract

                Objective: To assess the prevalence of abnormal anal cytology and high-risk HPV type infection in HIV-infected people with a CD4 cell count >300 cells/μl.

                Methods: The clinic-based patient population included 126 HIV infected people; 124 men who have sex with men (MSM), 2 women; median age 45 years; CD4 cell count >300 cells/μl. Anal cytology swabs were placed into liquid based medium for HPV typing by Hybrid Capture®-2 assay and cytological assessment, by a single cytopathologist.

                Results: 106 (84%) participants were infected with high-risk HPV; 17 (14%) had no high-risk types of HPV detected; three (2%) had no HPV assay result due to an inadequate sample. Sixteen (13%) participants had cytological evidence of high-grade squamous intraepithelial (HGSIL) changes, of whom 100% had high-risk HPV types detected and 13 (10%) had atypical squamous cells of undetermined significance with possible high grade changes (ASCUS-H), of whom 92% had high-risk HPV types detected. Low-grade changes (LSIL) were detected in 24 (19%) participants, of whom 96% had high-risk HPV types, 32 (25%) had ASCUS with 88% high-risk HPV types, 30 (24%) had normal cytology with 73% high-risk HPV types, and 11 (9%) samples were inadequate for cytological assessment. The odds ratio of having abnormal anal cytology in those participants with high-risk HPV on anal swab was 5.03 (C.I. 1.45-17.39).

                Discussion: High-risk HPV types are common in this HIV+ population with a CD4 cell count >300 cells/μl. The presence of high-risk HPV types was associated with abnormal anal cytology such as HGSIL and ASCUS-H.

                • Anal intraepithelial neoplasia
                • HIV
                • HPV
                • cytology
                • screening

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