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Abnormal anal cytology in high-risk human papilloma virus infection in HIV-infected Australians

¹ Carlton Clinic, Melbourne, Australia
² Infectious Diseases Unit, Alfred Hospital, Melbourne
³ Department of Medicine, Monash University, Melbourne
⁴ STI Research Centre, University of Sydney, Sydney, Australia
⁵ CSL Limited, Melbourne, Australia
⁶ Melbourne Pathology, Collingwood, Victoria, Australia

Correspondence to:
Dr J S Anderson, Carlton Clinic, 88 Rathdowne St, Carlton, Melbourne, Vic 3053, Australia

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.