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Clinical
Abnormal anal cytology in high-risk human papilloma virus infection in HIV-infected Australians
  1. J Anderson1,2,
  2. J Hoy2,3,
  3. R Hillman4,
  4. C Gittleson5,
  5. G Hartel5,
  6. G Medley6,
  7. R Basser5
  1. 1
    Carlton Clinic, Melbourne, Australia
  2. 2
    Infectious Diseases Unit, Alfred Hospital, Melbourne
  3. 3
    Department of Medicine, Monash University, Melbourne
  4. 4
    STI Research Centre, University of Sydney, Sydney, Australia
  5. 5
    CSL Limited, Melbourne, Australia
  6. 6
    Melbourne Pathology, Collingwood, Victoria, Australia
  1. Dr J S Anderson, Carlton Clinic, 88 Rathdowne St, Carlton, Melbourne, Vic 3053, Australia

Abstract

Objective: To assess the prevalence of abnormal anal cytology and high-risk human papilloma virus (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, and two 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 because of an inadequate sample. Sixteen (13%) participants had cytological evidence of high-grade squamous intraepithelial (HGSIL) changes, 100% of whom had high-risk HPV types detected, and 13 (10%) had atypical squamous cells of undetermined significance with possible high-grade changes (ASCUS-H), 92% of whom had high-risk HPV types detected. Low-grade changes (LSIL) were detected in 24 (19%) participants, 96% of whom 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 participants with high-risk HPV having abnormal anal cytology on anal swab was 5.03 (95% CI 1.45 to 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.

https://doi.org/10.1136/sti.2007.027250

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    Footnotes

    • Funding: The study was supported by CSL Ltd. RB, CG and GH are employees of CSL Ltd.

    • Competing interests: None declared.

    • The results of this study have been presented at the 22nd Papilloma Conference in Vancouver, Canada, in May 2005 (Anal intraepithelial neoplasia (AIN) and high-risk HPV types in HIV infected men and women with mild to moderate immunosuppression. P-242).