AEGiS-15IAC: The evaluation of anal dysplasia with anal cytology (PAP) followed by high resolution anoscopy (HRA) and biopsy in HIV-infected men.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

The evaluation of anal dysplasia with anal cytology (PAP) followed by high resolution anoscopy (HRA) and biopsy in HIV-infected men.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. ThOrB1407)

Lee A, Young T, Hanks D, Ung R, Stansell J
Positive Health Program/San Francisco General Hospital/University of California, San Francisco, CA, United States

Introduction: Anal cancer is one of the most common cancers that affect HIV-infected individuals.

METHODS: At the Positive Health Program at San Francisco General Hospital (SFGH), we have been screening HIV-infected men who have sex with men (MSM) with anal PAP since June 2001. Those with abnormal anal PAP findings were followed by high-resolution anoscopy (HRA) and biopsy. Between June 2001 to December 2003, we performed anal PAP screening on 417 HIV-infected MSM. During HRA, 3% acetic acid and Lugol's solution were applied to identify areas of dysplasia for biopsy. Biopsies were performed using Tischler forceps. Tissue was sent to the Pathology Department at SFGH for analysis. A concurrent anal PAP was sent with most biopsies for correlation. Many subjects had multiple follow-up exams over the 30 month period. A total of 192 specimens had paired PAP and biopsy samples available for analysis. Paired samples were used for the calculation of sensitivity of anal PAP screening. Abno rmal PAP and biopsy results included atypical squamous cells of uncertain significance (ASCUS), low grade dysplasia, high grade dysplasia and carcinoma. Sensitivity is calculated using the formula, (True Positive)/(True Positive + False Negative).

RESULTS: Out of 417 individuals screened, 189 (46%) had normal anal PAP, 121 (29%) had ASCUS, 85 (20%) had low grade dysplasia, 18 (4%) had high grade dysplasia, 4 (0.9%) had carcinoma. Of the 163 individuals with abnormal PAP who were followed up with HRA and biopsy, 31 (19%) had normal biopsies, 79 (48%) had low grade dysplasia, 28 (17%) had moderate dysplasia, 3 (2%) had high grade dysplasia, 13 (8%) had severe dysplasia, 6 (4%) had carcinoma and 3 (2%) had ASCUS on biopsy. The sensitivity of anal PAP screening in our institution is 0.95. Conclusion Although anal PAP is highly sensitive, it is crucial to follow-up abnormal anal PAP results with high-resolution anoscopy and biopsy for confirmation.

Keywords: AEGIS, HIV, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Anus, Anus Diseases, Biopsy, Anus Neoplasms, HIV Infections, Endoscopy, Gastrointestinal, Carcinoma, San Francisco, Humans, Male, pathology, cytology, methods

040711
ThOrB1407