Methods: Concomitant anal cytology, HR-HPV typing and high-resolution anoscopy (HRA)-guided anal biopsies were analyzed from a cohort of HIV-infected MSM with recent HCV infection. We compared these findings to a contemporary cohort of HIV-infected MSM without HCV infection who underwent primary screening using anal cytology, and were referred for HRA only if cytology results were abnormal (≥ASCUS).
Results: Sixty HIV-infected men with recent HCV and 1,710 HIV-infected men without HCV were evaluated between April 2009 and September 2014. Men with recent HCV were more likely than HCV-uninfected men to be white (78% and 26%, p<0.01) and to have higher CD4 counts (656 and 559 cells/μl, p=0.02); there were no differences in age, antiretroviral use, or HIV viral load suppression. Men with recent HCV were more likely to have at least one HR-HPV type (97% and 83% of specimens tested for HPV, p=0.02). Anal HSIL was found in 44% of men with recent HCV and in 34% of men without HCV (p=0.20). Among men with recent HCV, 14% with benign cytology and 48% with ASCUS on cytology had HSIL on anal biopsy.
Conclusion: HIV-infected MSM with recent HCV infection have high rates of anal HSIL, at least as high as those of HIV-infected MSM prescreened with abnormal anal cytology. These findings suggest that direct screening with HRA may be warranted for HIV-infected MSM with recent HCV infection due to both the high rates of HSIL and the low sensitivity of anal cytology to detect it.
K. Sigel, None
A. Foster, None
D. Fierer, None