The Addition of High-Risk HPV Testing to Anal Cytology Increases the Identification of Anal Dysplasia in HIV-Infected Patients

Conn Med. 2015 Aug;79(7):389-94.


Background: Anal dysplasia (AD) is prevalent in HIV-infected patients. Screening for AD is recommended for high-risk groups, including HIV-infected patients. We evaluated screening algorithms for AD using cytology, high-risk human papillomavirus (HRH) testing, or both.

Methods: HIV-infected patients were offered AD screening by both anal cytology and PCR-based detection of HRH. Patients with abnormal cytology (AC) or HRH genotypes were referred to the same oncologic surgeon for high-resolution anoscopy (HRA).

Results: Ninety patients underwent screening (84% men who have sex with men). Forty-four patients (52.6%) had abnormal screens (31.5% AC, 46% HRH). Twenty-six patients with AC and/or positive HRH had HRA. AC and nadir CD4+ cell count of < 200 cells/mm3 were predictors of abnormal histology on HRA by univariate analysis (OR 4.5 and 2.5, respectively). Using a log-linear model, we estimated that for every 49 cases with two normal screening tests, one case of AD would be missed. Conclusions: Universal screening for AD in an HIV+ population yielded a high percentage of abnormal findings. Addition of HRH to cytology screening increased positive screens by 24%. Larger studies are needed to determine the ideal screening method.

MeSH terms

  • Adult
  • Aged
  • Alphapapillomavirus / genetics*
  • Anal Canal / pathology*
  • Anal Canal / virology
  • Anus Diseases / diagnosis
  • Anus Diseases / epidemiology
  • Anus Diseases / etiology*
  • Connecticut / epidemiology
  • DNA, Viral / analysis*
  • Female
  • HIV Infections / complications*
  • HIV Infections / virology
  • HIV*
  • Human Papillomavirus DNA Tests
  • Humans
  • Male
  • Middle Aged
  • Papillomavirus Infections / complications
  • Papillomavirus Infections / diagnosis*
  • Papillomavirus Infections / virology
  • Prevalence
  • Retrospective Studies
  • Risk Factors
  • Young Adult


  • DNA, Viral