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High-risk human papilloma vrus testing improves diagnostic performance to predict moderate-to high-grade anal Intraepithelial neoplasia in human immunodeficiency virus-infected men who have xex with men in low-to-absent cytological abnormalities

AuthorsViciana, Pompeyo; Milanés-Guisado, Yusnelkis; Fontillón, María; Domínguez Castaño, Ana; Sotomayor, César; Espinosa, Nuria; López-Cortés, Luis F. CSIC; Neukam, Karin
KeywordsAnal liquid-based cytology
Human papillomavirus
Diagnostic performance
Squamous intraepithelial lesions
HIV-infected men who have sex with men
Issue Date2019
PublisherOxford University Press
CitationClinical Infectious Diseases 69(12): 2185-2192 (2019)
Abstract[Background]: Screening methods for anal squamous intraepithelial lesions (SILs) are suboptimal. We aimed to determine the diagnostic performance of a composite endpoint comprising anal liquid-based cytology (aLBC) and high-risk human papillomavirus (HR-HPV) testing to predict histological high-grade SILs (hHSILs). [Methods]: From the SeVIHanal cohort, human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) who had an aLBC with concomitant HR-HPV testing were included. hHSILs were determined by high-resolution anoscopy (HRA)-guided biopsy. [Results]: A total of 705 visits obtained from 426 patients were included. The prevalence of HR-HPV among aLBC results were 51.9% (133/215) normal, 87.9% (20/232) low-grade SILs (LSILs), and 90.9% (149/164) high-grade SILs; P (linear association) <. 001. Low prevalence of hHSILs was only observed for the composite aLBC/HR-HPV testing endpoint >normal/noHR-HPV> (10%) and >LSIL/noHR-HPV> (4%). The prognostic values (95% confidence interval) for HR-HPV to predict hHSILs in normal cytology were positive predictive value (PPV), 29.3% (25.6%-33.3%); negative predictive value (NPV), 90.2% (82.8%-94.7%); sensitivity, 83% (69.2%-92.4%); and specificity, 44.1% (36.4%-51.9%). Corresponding figures for cytologic LSILs were PPV, 39.2% (37.4%-41.1%); NPV, 96.4% (78.9%-99.5%); sensitivity, 98.8% (93.3%-99.9%); and specificity, 17.9% (12.1%-24.9%). A positive interaction and a synergistic effect for the composite endpoint were observed (relative excess risk = 1.50, attributable proportion of histological results to interaction = 0.17, synergy index = 1.24). [Conclusions]: HRA should not be indicated in the setting of LSILs/noHR-HPV following aLBC-based screening. In contrast, HIV-infected MSM with normal aLBC/HR-HPV infection should be considered for HRA. Clinical Trials Registration: NCT03713229.
Publisher version (URL)https://doi.org/10.1093/cid/ciz144
Identifiersdoi: 10.1093/cid/ciz144
e-issn: 1537-6591
issn: 1058-4838
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