High-risk human papilloma virus testing improves diagnostic performance to predict moderate-to-high grade anal intraepithelial neoplasia in HIV-infected men who have sex with men in low-to-absent cytological abnormalities.

BACKGROUND: Screening methods for anal intraepithelial neoplasia (AIN) are suboptimal. This study 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 squamous intraepithelial lesions (HSIL).

METHODS: From a cohort of HIV-infected men who have sex with men (MSM) seen at a Spanish University hospital, all individuals who had an aLBC with concomitant HR-HPV testing were included. Histological HSIL (hHSIL) were determined by high-resolution anoscopy (HRA)-guided biopsy and included AIN grade II-III.

RESULTS: A total of 705 visits obtained from 426 subjects were included. The prevalence of HR-HPV among the different aLBC results were: 51.9% (133/215) normal, 87.9% (20/232) low-grade squamous intraepithelial lesions (LSIL) and 90.9% (149/164) HSIL; p (linear association)<0.001. Low prevalences of hHSIL were 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 hHSIL 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%); specificity 44.1% (36.4%-51.9%). Corresponding figures for cytologic LSIL were: PPV, 39.2% (37.4%-41.1%); NPV, 96.4% (78.9%-99.5%); sensitivity, 98.8% (93.3%-99.9%); specificity, 17.9% (12.1%-24.9%).A positive interaction and a synergistic effect for the composite endpoint was observed (relative excess risk=1.50, attributable proportion of histological results to the interaction=0.17, synergy index=1.24).

CONCLUSION: HRA should not be indicated in the setting of LSIL/noHR-HPV following aLBC-based screening. In contrast, HIV-infected MSM with normal aLBC but HR-HPV infection should be considered for HRA.