Xpert HPV as a Screening Tool for Anal Histologic High-Grade Squamous Intraepithelial Lesions in Women Living With HIV. (1st July 2021)

• Record Type: Journal Article
• Authors: Ellsworth, Grant B.; Stier, Elizabeth A.; Chiao, Elizabeth Y.; Lensing, Shelly Y.; Darragh, Teresa; Jay, Naomi; Berry-Lawhorn, J. Michael; Einstein, Mark; Barroso, Luis F.; Cranston, Ross D.; Levine, Rebecca; Guiot, Humberto M.; French, Audrey L.; Goldstone, Stephen E.; Preiser, Wolfgang; Claassen, Mathilda; Palefsky, Joel M.; Wilkin, Timothy J.
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 87:Number 3(2021)
• Publication Date: 2021-07-01
• Subjects: HIV -- human papillomavirus -- anal cancer -- women -- cancer prevention; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000002672
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Background: Women living with HIV (WLWH) experience high rates of anal cancer. Screening using anal cytology, high-resolution anoscopy (HRA) with biopsies, can histologically diagnose anal cancer precursors called high-grade squamous intraepithelial lesions (HSIL). The low specificity of screening using anal cytology results in HRA referral for many WLWH without HSIL. Screening using high-risk human papillomavirus (HR-HPV) may improve specificity. Methods: Two hundred seven WLWH (63% non-Hispanic black) were screened for anal histologic HSIL (hHSIL) using cytology, HRA-guided biopsies, and Xpert HPV. Xpert performance for predicting anal hHSIL was compared with that of cytology. Usng Xpert 5 HPV genotypic results and accompanying cycle thresholds, receiver operator characteristic curve and recursive partitioning analyses were used to create predictive models for hHSIL. Results: The performance of Xpert to predict hHSIL was not different from that of cytology with a sensitivity (Sn) of 89% and specificity (Sp) of 49%. Interpretation of Xpert was modified using genotypic results and receiver operator characteristic curve analysis, which produced a screen with an Sn and Sp of 75% and 84% for hHSIL, respectively. Another reinterpretation of Xpert was created using recursive partitioning and cycle thresholds, which predicted hHSIL with an Sn and Sp of 75% and 86%, respectively. The detection of HPV-16 was highly predictive of hHSIL in all analyses. These modified screening tests would reduce HRA referral in this population by almost half compared with anal cytology. Conclusions: Xpert HPV is an alternative to anal cytology to screen for anal HSIL and can be optimized to reduce the number of unnecessary HRAs performed in WLWH. Abstract : Supplemental Digital Content is Available in the Text.