Comparison of anal cancer screening strategies including standard anoscopy, anal cytology, and HPV genotyping in HIV-positive men who have sex with men

Br J Cancer. 2018 Aug;119(3):381-386. doi: 10.1038/s41416-018-0176-9. Epub 2018 Jul 20.


Background: There is no consensus on screening strategy of high-grade intraepithelial neoplasia (HGAIN). Guidelines range from clinical examination with digital anorectal examination followed by standard anoscopy (SA), to anal cytology (Pap)+/- HPV genotyping. We compared screening strategy yields based on Pap, SA, and HPV-16 genotyping alone or in combination in HIV-MSM.

Methods: Pap, SA, and HPV-16 genotyping were performed in all HIV-MSM attending a first anal cancer screening consultation in Paris, France. High-resolution anoscopy, the gold standard to detect HGAIN, was performed in the case of HPV-16 positivity or abnormal cytology. Yield was defined as the number of patients with HGAIN relative to the total number of patients screened.

Results: On 212 patients, the complete strategy (SA + Pap + HPV genotyping) yield (12.7%) was significantly higher than that of SA (3.3%, p < 0.001) and HPV-16 alone (6.6%, p < 0.05). Although none of the other strategies were significantly different from the complete strategy, Pap + HPV-16 and Pap + SA had closer yields (about 11%), with OR = 0.83 (95% CI [0.44;1.57]) and 0.87 (95% CI [0.46;1.64]), respectively.

Conclusions: Pap combined with HPV-16 genotyping or SA tended towards higher yields compared to Pap alone, and closer to that of the complete strategy.

MeSH terms

  • Adult
  • Anal Canal / pathology
  • Anal Canal / virology
  • Anus Neoplasms / diagnosis*
  • Anus Neoplasms / genetics
  • Anus Neoplasms / pathology
  • Anus Neoplasms / virology
  • Cytodiagnosis
  • Early Detection of Cancer*
  • France
  • Genotype
  • HIV / genetics*
  • HIV / pathogenicity
  • HIV Infections / genetics
  • HIV Infections / virology
  • Homosexuality, Male
  • Human papillomavirus 16 / genetics*
  • Human papillomavirus 16 / pathogenicity
  • Humans
  • Male
  • Middle Aged
  • Papanicolaou Test
  • Papillomavirus Infections / diagnosis*
  • Papillomavirus Infections / genetics
  • Papillomavirus Infections / pathology
  • Papillomavirus Infections / virology
  • Sexual and Gender Minorities