HIV-Infected Patients with Anal Cancer Precursors: Clinicopathological Characteristics and HPV Subtype Distribution.

BACKGROUND: People living with HIV have high rates of anal human papillomavirus infection and anal precancer/cancer. OBJECTIVE: (1) Determine human papillomavirus subtype distribution among people living with HIV with anal high-grade squamous intraepithelial lesions. (2) Compare clinicopathological characteristics of anal high-grade squamous intraepithelial lesions patients by human papillomavirus 16 status. (3) Investigate high-risk human papillomavirus negative anal high-grade squamous intraepithelial lesions cases. DESIGN: In this retrospective study, 700 people living with HIV with biopsy-proven anal high-grade squamous intraepithelial lesions were reviewed for demographics, cytological diagnoses, and human papillomavirus testing results for human papillomavirus 16, 18, and 12 other high-risk types. For human papillomavirus-negative subjects, corresponding biopsies were genotyped using real-time PCR. SETTINGS: A large urban HIV clinic system and major referral center for anal cancer screening PATIENTS:: Median age was 46 years (range, 20-76). Ninety-one percent were men who have sex with men. MAIN OUTCOME MEASURES: Association between demographic variables and human papillomavirus 16 status. RESULTS: Anal cytology was unsatisfactory (5%), benign (13%), atypical squamous cells of undetermined significance (35%), low-grade squamous intraepithelial lesion (36%), and high-grade squamous intraepithelial lesions (11%). Human papillomavirus co-testing results were negative (n=38, 5%), human papillomavirus 16 (n=303, 43%), human papillomavirus 18 (n=78, 11%), or exclusively non-16/18 types (n=281, 40%). Human papillomavirus 16-positivity was associated with >/=3 high-grade lesions and >/= atypical squamous cells of undetermined significance cytology (p 0.05). For human papillomavirus-negative cases, human papillomavirus genotyping of biopsies was positive for high-risk (n=14, 36%) or possibly carcinogenic types (n=12, 32%), or negative (n=12, 32%). LIMITATIONS: Retrospective data analysis, pooled results for 12 high-risk human papillomavirus types rather than individual types. CONCLUSIONS: Nearly all people living with HIV and anal high-grade squamous intraepithelial lesions test positive for high-risk human papillomavirus on anal swabs; negative results may be due to sampling error, L1-based PCR assay or human papillomavirus types not captured by standard clinical assays. Human papillomavirus 16-positive anal high-grade squamous intraepithelial lesions patients are indistinguishable from others based on demographic and clinical characteristics, underscoring the potential role of human papillomavirus testing for anal cancer screening. See Video Abstract at http://links.lww.com/DCR/B208.