Anal cytological abnormalities in human immunodeficiency virus-infected men and prevalence of high-risk human papillomavirus co-infection

Background: Human immunodeficiency virus (HIV) infects cells of the immune system, leading to a compromised and depleted immune system. Progressive failure of the immune system predisposes an individual to many life-threatening opportunistic infections and malignancies. As compared to the general population, the incidence of anal squamous cell carcinoma (ASCC) is substantially higher in HIV-infected individuals. Majority of ASCC are related to infections caused by high-risk strains of human papillomavirus (HPV). Aims: We conducted an observational study on HIV-positive men who had a history of homosexual contact. The aim of this study was to assess the spectrum of cytological abnormalities on anal smear cytology in individuals with HIV infection, and also estimate the prevalence of anal infection with high-risk HPV strains. Materials and Methods: We enrolled 56 individuals for this pilot study. This study involved the collection of specimens from the anal canal of the patients by using cytobrush in liquid-based cytology (LBC) vial. The sample was simultaneously tested for cytological abnormalities by LBC (Sure Path, BD) and for 13 high-risk strains by Hybrid Capture II technique (Qiagen) based on antibody capture and chemiluminescent signal detection. Anal smear cytology was reported as per guidelines of The Bethesda System of reporting anal cytology, 2014. Results: The prevalence of high-risk HPV infection was seen in 41.07% of individuals and low-grade squamous intraepithelial lesion and atypical squamous cells of undetermined significance were seen in 12.5% and 16.07% individuals, respectively. Cytology was useful in 7% of cases to diagnose opportunistic infections. The latter is a field yet to be tapped. Conclusion: We would recommend LBC in HIV-positive patients, for screening of cytological abnormalities and HPV status. This would also give an opportunity to screen for opportunistic infections, which have otherwise not been diagnosed.