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Title
Role of low-risk HPV PCR in screening for HSIL lesions and anal cancer in men who have sex with men (MSM) living with HIV (MSM-LWHIV)
Presenter
Carmen Hidalgo Tenorio
Authors
C. Hidalgo Tenorio1, C. Garcia Martinez2, R. Moya2, P. Gomez Ronquillo2, M. Omar Mohamed3, J. Lopez Hidalgo4
Institutions
1Hospital Universitario Virgen de las Nieves. Instituto de Investigación Biosanitario de Granada (IBS-Granada), Infectious Diseases Unit, Granada, Spain, 2Hospital Universitario Virgen de las Nieves. Instituto de Investigación Biosanitario de Granada (IBS-Granada), Internal Medicine Service, Granada, Spain, 3Complejo Hospitalario de Jaen, Infectious Diseases Unit, Jaen, Spain, 4Hospital Universitario Virgen de las Nieves. Instituto de Investigación Biosanitario de Granada (IBS-Granada), Pathology Service, Geanada, Spain

BACKGROUND: Anal squamous cell carcinoma (ASCC) is one of the most frequent non-AIDS-defining neoplasia in PLWHIV, mainly in MSM, and it has been associated with chronic infection by human papilloma virus(HPV). Main: Analyze the value of low-risk HPV PCR in screening for "high-grade squamous intraepithelial lesions and anal cancer" (HSIL-plus). Secondary objectives: To analyze the rate of patients with LSIL (AIN1) who progress to HSIL-plus and the factors associated with this progression.
METHODS: This is a prospective, longitudinal study that consecutively included 493 MSM-LWHIV between May 2010 and December 2021, followed up 43 months (IQR:12-76). At the baseline visit clinical-epidemiological, and analytical variables related to HIV were included, and anal cytology was performed to study the detection and genotyping of HPV (Linear Array HPV Genotyping Test) and cytological study using the "thin-layer technique"[Thin Prep 2000 processor(Hologic)], and high-resolution anoscopy (HRA) with the Carl Zeiss 150fc© colposcope,(Carl Zeiss,Oberkochen,Germany).Follow-up visits were made based on the HRA results(in case of normal result or AIN1, annually; in case of HSIL-plus the HRA was carried out at the end of the treatment) during the which the HIV infection was reassessed, sexual behavior,and HPV infection.
RESULTS: The subjects included were 36y, 23.1% had CD4 nadir <200 cells/uL. 15% had received the quadrivalent HPV vaccine >5 years ago. Mono-infection due to low-risk HPV genotypes in patients with normal cytology ruled out HSIL plus in 100% of cases (S 100%, E 91.9%, PPV 2.9% and NPV 100%). The rate of patients who progressed from LSIL to HSIL plus was 4.7% at a median time of 12months (IQR:12-12).Risk factors for progression from LSIL to HSIL-plus during follow-up were acquisition of high-risk HPV genotypes (HR:4.15; IC 95%:1.14-15.03),low-risk HPV genotypes[[(HR:3.68 IC95%:1.04-12.94), in particular genotype 6 (HR:4.47, IC95%:1.34-14.91)] and history of AIDS (HR:5.81, 95%CI:1.78-18.92).
CONCLUSIONS: Anal mono-infection with low-risk HPV genotypes in MSM-LWHIV with normal cytology is not associated with precursor lesions or ASCC. The rate of progression from LSIL to HSIL-plus was less than 5%, which was related to the acquisition of high and low risk HPV genotypes (specifically 6) and a history of AIDS.

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