Methods: We performed a retrospective chart review of HIV infected men at the Grady Ponce de Leon Center in Atlanta, GA referred for high resolution anoscopy (HRA) between December 2013-September 2015. Multivariate logistic regression was performed with HGAIN as the binary outcome, alpha level = 0.05.
Results: 147 men presented for HRA: 98% were referred for abnormal anal cytology: 88% low grade (atypical squamous cells of undetermined significance, ASCUS, or low grade squamous intraepithelial lesion, LGSIL) and 12% high grade (atypical squamous cells cannot rule out high grade, ASC-H, or high grade squamous intraepithelial lesion, HGSIL), 72% were black, and 94% were men who have sex with men or men who have sex with men and women. All had a diagnosis of AIDS; CD4 count closest to time of HRA was a mean 359 cells/mm3(SD 214), and 69% had an undetectable HIV viral load. 137/147 (93%) with available anal cytology and histology data from day of HRA were included in the analyses: 94% had abnormal anal cytology (80% ASCUS/LGSIL and 20% ASC-H/HGSIL), and 97% had abnormal histology (35% LGAIN, 65% HGAIN). There were no cases of anal cancer. In multivariate logistic regression, statistically significant variables associated with HGAIN included number of biopsies (OR 1.5, 95% CI 1.1-2.1, p <0.05) and having ≥ 1 high grade anal cytology in the last 12 months (OR 4.1, 95% CI 1.5-11.1, p <0.05). No significant association was found between CD4 count, HIV viral load, or recent sexually transmitted infection and HGAIN.
Conclusion: In this study, having ≥ 1 high grade anal cytology in the last 12 months was associated with HGAIN, even if the most recent cytology was low grade. As practitioners do not visualize the anal transformation zone when collecting anal cytology, high grade lesions may be missed with a single anal pap. Future larger longitudinal studies are needed to determine optimal frequency of anal cytology and create a risk stratification score to identify HIV-infected patients at highest risk of HGAIN.
M. L. Nguyen, None
C. C. Mehta, None
M. Mosunjac, None
L. Flowers, None