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Liu Y, Bhardwaj S, Sigel K, Winters J, Terlizzi J, Gaisa MM. Anal cancer screening results from 18-to-34-year-old men who have sex with men living with HIV. Int J Cancer 2024; 154:21-27. [PMID: 37728489 PMCID: PMC10842989 DOI: 10.1002/ijc.34734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/05/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
Men who have sex with men living with HIV (MSM LWH) are at highest risk for human papillomavirus (HPV)-associated anal cancer. There is no consensus on the optimal screening initiation age. This study aimed to assess the prevalence and severity of anal HPV disease among MSM LWH under the age of 35, which is a currently proposed screening age threshold. Between 2014 and 2020, 1255 18-to-34-year-old MSM LWH underwent anal cytology screening. 916 were co-tested for high-risk HPV (HR-HPV). 467 underwent high-resolution anoscopy (HRA) and biopsy. Cancer registry data were queried. Predictors of abnormal cytology (ie, ≥ASCUS) and histological high-grade squamous intraepithelial lesions (HSIL) were evaluated using unadjusted logistic regression models. Median age was 28 years (range, 18-34). 19% received at least one dose of HPV vaccine. Abnormal cytology rate was 65%. HR-HPV and HPV16 prevalence were 87% and 30%. Biopsy results were benign (10%), LSIL (43%) and HSIL (47%). No cases of prevalent or incident anal cancers were detected. Findings were similar between age subgroups (18-24, 25-29 and 30-34) except for a higher prevalence of AIN 3 in the 30-34 group (19%). Abnormal cytology was significantly associated with HR-HPV infection. Histological HSIL was associated with HR-HPV infection and cytological LSIL or worse. The absence of anal cancer in a large cohort of MSM LWH under the age of 35, despite high prevalence of anal HR-HPV infection and precancer, supports an age-based anal cancer screening strategy for MSM LWH.
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Affiliation(s)
- Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Swati Bhardwaj
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Winters
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph Terlizzi
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael M. Gaisa
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Liu Y, Weiss K, Zamudio AR, Hayes MP, Saleh M, Gaisa MM, Sigel K. Primary Anal Cancer Screening Results From 381 Women With Human Immunodeficiency Virus. J Infect Dis 2023; 227:932-938. [PMID: 36196502 PMCID: PMC10319954 DOI: 10.1093/infdis/jiac398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/27/2022] [Accepted: 09/30/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women with human immunodeficiency virus (WWH) have an elevated risk for human papillomavirus (HPV)-associated anal cancer. Primary anal cancer screening results from this population could inform practice guidelines. METHODS In total, 381 WWH with anal cytology screening, high-risk HPV (hrHPV) testing and genital (cervical or vaginal) cotesting within 6 months were identified during 2012-2019. Those with anal cytology of atypical squamous cells of undetermined significance (ASCUS) or worse underwent high-resolution anoscopy and biopsy. Independent predictors of anal hrHPV, HPV16, and histological anal high-grade squamous intraepithelial lesions (aHSIL) were identified using adjusted logistic regression models. RESULTS Prevalence of anal hrHPV, HPV16, and ASCUS or worse cytology was 61%, 13%, and 68%. Histological aHSIL was detected in 42% of WWH with ASCUS or worse anal cytology. Prevalence of genital hrHPV, HPV16, and ASCUS or worse cytology was 30%, 4%, and 28%. Genital hrHPV predicted anal hrHPV (odds ratio [OR], 5.05), while genital HPV16 predicted anal HPV16 (OR, 9.52). Genital hrHPV and anal HPV16 predicted histological aHSIL (ORs, 2.78 and 10.9). CONCLUSIONS Anal HPV disease was highly prevalent in this primary screening cohort of WWH. While genital screening results predicted anal disease, rates of isolated anal HPV disease were substantial, supporting universal anal cancer screening for this population.
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Affiliation(s)
- Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kevin Weiss
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrés Ramírez Zamudio
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Monica Prasad Hayes
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mona Saleh
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael M Gaisa
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Kutner BA, Simoni JM, DeWitt W, Gaisa MM, Sandfort TG. Gay and Bisexual Men Who Report Anal Sex Stigma Alongside Discomfort Discussing Anal Sex with Health Workers Are Less Likely to Have Ever Received an Anal Examination or Anal Swab. LGBT Health 2022; 9:103-113. [PMID: 35133893 PMCID: PMC8968851 DOI: 10.1089/lgbt.2021.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: We sought to determine whether stigma toward anal sexuality was associated with having ever received an anal examination or anal swab among gay and bisexual men (GBM). Methods: In 2017, we conducted a cross-sectional online survey with 1513 adult cisgender GBM living in the United States. We used structural equation modeling to test whether the Anal Sex Stigma Scales (a validated measure comprising provider stigma, self-stigma, and silence) was negatively associated with lifetime receipt of anorectal examination or anal swabbing by a medical provider. The model assessed mediation by respondents' comfort discussing anal sex practices with health workers and adjusted for possible confounders. Results: As hypothesized, anal sex stigma was associated with less comfort discussing anal sex (β = -0.44, 95% confidence interval [CI]: -0.50 to -0.38, p < 0.001), and greater comfort was associated with greater likelihood of screening (β = 0.28, 95% CI: 0.19 to 0.37, p < 0.001). The model demonstrated good fit (root mean square error of approximation = 0.045, comparative fit index, and Tucker-Lewis index each = 0.99) and adjusted for everyday discrimination, social support specific to anal sex, age, income, education, medical coverage, outness, and ethnic/racial identification. Collectively, model variables accounted for 48% of the variance in screening (p < 0.001). Conclusion: GBM who endorsed less anal sex stigma reported greater comfort discussing anal sex with health workers and were more likely to have ever received anal health screening by a medical provider. To improve anal health and cancer prevention among GBM, anal sex stigma and related discomfort discussing anal sex with health workers are targets for intervention.
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Affiliation(s)
- Bryan A. Kutner
- The HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Will DeWitt
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Michael M. Gaisa
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Theodorus G.M. Sandfort
- The HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, New York, USA
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Liu Y, McCluggage WG, Darragh TM, Farhat N, Blakely M, Sigel K, Zheng W, Westra WH, Gaisa MM. p16 Immunoreactivity Correlates With Morphologic Diagnosis of HPV-associated Anal Intraepithelial Neoplasia: A Study of 1000 Biopsies. Am J Surg Pathol 2021; 45:1573-1578. [PMID: 34231547 DOI: 10.1097/pas.0000000000001769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
p16 is the most useful diagnostic marker for human papillomavirus (HPV)-associated anogenital lesions. In the cervix, the pattern of p16 immunoreactivity generally correlates with lesion severity. p16 expression in anal intraepithelial neoplasia (AIN) is far less studied. Whether such correlation holds true has to be determined. We correlated the degree and pattern of p16 immunohistochemistry (IHC) results with morphologic diagnoses of 1000 anal squamous and transitional zone biopsy specimens. Using the Lower Anogenital Squamous Terminology criteria, p16 IHC results were classified as block staining, partial staining, or negative. Among 150 samples without morphologic evidence of AIN, p16 was negative in 85% and partial staining in 15%. AIN 1 (n=400) revealed diverse results: 28% negative, 35% partial, and 37% block staining. Among AIN 2 (n=298), 89% were block, 9% partial staining, and 2% negative. AIN 3 (n=152) revealed block (95%) or partial staining (5%). For the detection of AIN 2/3, p16 block staining yielded 91% sensitivity, 73% specificity, 80% positive predictive value, 91% negative predictive value, and a Youden Index of 0.64. Combining block staining and partial staining slightly increased sensitivity (99%) and negative predictive value (98%), but significantly decreased specificity (43%), positive predictive value (59%) and Youden Index (0.42, P<0.001). As with the cervix, p16 immunoreactivity correlates with morphologic diagnoses of AIN. Block staining offers the optimal diagnostic value for AIN 2/3. Caution is required since AIN 1 frequently exhibits block staining; the prognostic value of p16 warrants further investigation.
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Affiliation(s)
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Teresa M Darragh
- Department of Pathology, University of California, San Francisco
| | - Nada Farhat
- Department of Pathology, New York Eye and Ear Infirmary of Mount Sinai Icahn School of Medicine, New York, NY
| | - Morgan Blakely
- Department of Pathology, University of California Los Angeles, Los Angeles, CA
| | - Keith Sigel
- Department of Medicine, Division of General Internal Medicine
| | - Wenxin Zheng
- Department of Pathology, Obstetrics and Gynecology, Simon Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Michael M Gaisa
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai
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Silvera R, Martinson T, Gaisa MM, Liu Y, Deshmukh AA, Sigel K. The other side of screening: predictors of treatment and follow-up for anal precancers in a large health system. AIDS 2021; 35:2157-2162. [PMID: 34014851 PMCID: PMC8808754 DOI: 10.1097/qad.0000000000002948] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anal cancer disproportionately affects people with HIV (PWH). High-grade squamous intraepithelial lesions (HSIL) are cancer precursors and treating them might prevent anal cancer. Data on adherence to HSIL treatment and surveillance is limited but needed to identify deficiencies of screening strategies. METHODS We collected data on high-resolution anoscopy (HRA) attendance and outcomes from 2009 to 2019 in a large urban anal cancer-screening program. Patients with an initial HSIL diagnosis were followed for return for HSIL electrocautery ablation within 6 months of index HSIL diagnosis, and follow-up HRA within 18 months of index HSIL diagnosis. We also evaluated predictors of these outcomes in univariable and multivariable analyses. RESULTS One thousand one hundred and seventy-nine unique patients with an anal HSIL diagnosis were identified and 684 (58%) returned for electrocautery ablation. Of those treated, only 174 (25%) and only 9% of untreated HSIL patients (47 of 495) underwent surveillance HRA within 18 months of index HSIL diagnosis. In multivariable analyses, black patients and PWH regardless of virologic control were less likely to undergo HSIL ablation within 6 months of HSIL diagnosis whereas patients with commercial insurance were more likely to be treated within 6 months of diagnosis. Among treated HSIL patients, PWH with viremia had a lower likelihood of engaging in post-treatment surveillance within 18 months of HSIL diagnosis. DISCUSSION Even in large specialized anal cancer screening programs adherence to HSIL treatment and surveillance is low. Psychosocial and economic determinants of health may impact retention in care. Addressing both personal and structural barriers to patient engagement may improve the effectiveness of anal cancer screening.
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Affiliation(s)
- Richard Silvera
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tyler Martinson
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael M. Gaisa
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashish A. Deshmukh
- Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX, USA
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, and
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Wei F, Gaisa MM, D'Souza G, Xia N, Giuliano AR, Hawes SE, Gao L, Cheng SH, Donà MG, Goldstone SE, Schim van der Loeff MF, Neukam K, Meites E, Poynten IM, Dai J, Combes JD, Wieland U, Burgos J, Wilkin TJ, Hernandez AL, Iribarren Díaz M, Hidalgo-Tenorio C, Valencia Arredondo M, Nyitray AG, Wentzensen N, Chow EP, Smelov V, Nowak RG, Phanuphak N, Woo YL, Choi Y, Hu Y, Schofield AM, Woestenberg PJ, Chikandiwa AT, Hickey AC, de Pokomandy A, Murenzi G, Péré H, Del Pino M, Ortiz AP, Charnot-Katsikas A, Liu X, Chariyalertsak S, Strong C, Ong JJ, Yunihastuti E, Etienney I, Ferré VM, Zou H, Segondy M, Chinyowa S, Alberts CJ, Clifford GM. Epidemiology of anal human papillomavirus infection and high-grade squamous intraepithelial lesions in 29 900 men according to HIV status, sexuality, and age: a collaborative pooled analysis of 64 studies. Lancet HIV 2021; 8:e531-e543. [PMID: 34339628 PMCID: PMC8408042 DOI: 10.1016/s2352-3018(21)00108-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/29/2021] [Accepted: 05/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Robust age-specific estimates of anal human papillomavirus (HPV) and high-grade squamous intraepithelial lesions (HSIL) in men can inform anal cancer prevention efforts. We aimed to evaluate the age-specific prevalence of anal HPV, HSIL, and their combination, in men, stratified by HIV status and sexuality. METHODS We did a systematic review for studies on anal HPV infection in men and a pooled analysis of individual-level data from eligible studies across four groups: HIV-positive men who have sex with men (MSM), HIV-negative MSM, HIV-positive men who have sex with women (MSW), and HIV-negative MSW. Studies were required to inform on type-specific HPV infection (at least HPV16), detected by use of a PCR-based test from anal swabs, HIV status, sexuality (MSM, including those who have sex with men only or also with women, or MSW), and age. Authors of eligible studies with a sample size of 200 participants or more were invited to share deidentified individual-level data on the above four variables. Authors of studies including 40 or more HIV-positive MSW or 40 or more men from Africa (irrespective of HIV status and sexuality) were also invited to share these data. Pooled estimates of anal high-risk HPV (HR-HPV, including HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68), and HSIL or worse (HSIL+), were compared by use of adjusted prevalence ratios (aPRs) from generalised linear models. FINDINGS The systematic review identified 93 eligible studies, of which 64 contributed data on 29 900 men to the pooled analysis. Among HIV-negative MSW anal HPV16 prevalence was 1·8% (91 of 5190) and HR-HPV prevalence was 6·9% (345 of 5003); among HIV-positive MSW the prevalences were 8·7% (59 of 682) and 26·9% (179 of 666); among HIV-negative MSM they were 13·7% (1455 of 10 617) and 41·2% (3798 of 9215), and among HIV-positive MSM 28·5% (3819 of 13 411) and 74·3% (8765 of 11 803). In HIV-positive MSM, HPV16 prevalence was 5·6% (two of 36) among those age 15-18 years and 28·8% (141 of 490) among those age 23-24 years (ptrend=0·0091); prevalence was 31·7% (1057 of 3337) among those age 25-34 years and 22·8% (451 of 1979) among those age 55 and older (ptrend<0·0001). HPV16 prevalence in HIV-negative MSM was 6·7% (15 of 223) among those age 15-18 and 13·9% (166 of 1192) among those age 23-24 years (ptrend=0·0076); the prevalence plateaued thereafter (ptrend=0·72). Similar age-specific patterns were observed for HR-HPV. No significant differences for HPV16 or HR-HPV were found by age for either HIV-positive or HIV-negative MSW. HSIL+ detection ranged from 7·5% (12 of 160) to 54·5% (61 of 112) in HIV-positive MSM; after adjustment for heterogeneity, HIV was a significant predictor of HSIL+ (aPR 1·54, 95% CI 1·36-1·73), HPV16-positive HSIL+ (1·66, 1·36-2·03), and HSIL+ in HPV16-positive MSM (1·19, 1·04-1·37). Among HPV16-positive MSM, HSIL+ prevalence increased with age. INTERPRETATION High anal HPV prevalence among young HIV-positive and HIV-negative MSM highlights the benefits of gender-neutral HPV vaccination before sexual activity over catch-up vaccination. HIV-positive MSM are a priority for anal cancer screening research and initiatives targeting HPV16-positive HSIL+. FUNDING International Agency for Research on Cancer.
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Affiliation(s)
- Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Michael M Gaisa
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Stephen E Hawes
- Department of Epidemiology, Department of Health Services, and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Maria Gabriella Donà
- Sexually Transmitted Infections/HIV Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Stephen E Goldstone
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands; Department of Internal Medicine, Amsterdam institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Karin Neukam
- Unidad Clínica de Enfermedades Infecciosas y Medicina Preventiva, UCEIMP, Instituto de Biomedicina de Sevilla, CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Elissa Meites
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - I Mary Poynten
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jianghong Dai
- School of Public Health, Xinjiang Medical University, Xinjiang, Urumqi, China
| | - Jean-Damien Combes
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Ulrike Wieland
- Institute of Virology, University of Cologne, National Reference Center for Papilloma and Polyomaviruses, Cologne, Germany
| | - Joaquin Burgos
- Department of infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Timothy J Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Alexandra L Hernandez
- Department of Medicine, University of California, San Francisco, CA, USA; Public Health Program, College of Education and Health Sciences, Touro University, Vallejo, CA, USA
| | - Mauricio Iribarren Díaz
- Department of Surgery, Complexo Hospitalario Universitario de Vigo-Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Carmen Hidalgo-Tenorio
- Infectious Disease Unit, Biosanitary Research Institute Granada, University Hospital Virgen de las Nieves, Granada, Spain
| | - Marleny Valencia Arredondo
- Universidad de Antioquia, Escuela de Microbiología, Grupo de investigación Salud Sexual y Cáncer, Medellín, Antioquia, Colombia
| | - Alan G Nyitray
- Clinical Cancer Center and Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Eric Pf Chow
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Vitaly Smelov
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France; Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand; Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | - Yin Ling Woo
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yoojin Choi
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Yifei Hu
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
| | - Alice M Schofield
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Petra J Woestenberg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Admire T Chikandiwa
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew C Hickey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre and Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Gad Murenzi
- Rwanda Military Hospital and Research for Development Rwanda, Kigali, Rwanda
| | - Hélène Péré
- Assistance Publique Hôpitaux de Paris-Centre, Service de Microbiologie (Unité de virologie), Hôpital Européen Georges Pompidou, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, Functional Genomics of Solid Tumors Laboratory, Equipe Labellisée Ligue Nationale contre le Cancer, Labex OncoImmunology, Paris, France
| | - Marta Del Pino
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Gynecology Oncology Unit, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Medicine Faculty, Barcelona University, Barcelona, Spain
| | - Ana P Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA; Graduate School of Public Health, University of Puerto Rico, San Juan, PR, USA
| | - Angella Charnot-Katsikas
- Department of Pathology, The University of Chicago, Chicago, IL, USA; MolDx Program, Palmetto GBA, Columbia, SC, USA
| | - Xing Liu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Suwat Chariyalertsak
- Faculty of Public Health, Chiang Mai University and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Carol Strong
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Evy Yunihastuti
- Department of Internal Medicine, University of Indonesia, Jakarta, Indonesia
| | | | - Valentine M Ferré
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Service de Virologie, Hôpital Bichat, Paris, France; Decision Science in Infectious Disease Prevention, Control and Care, INSERM, Université de Paris, Paris, France
| | - Huachun Zou
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia; School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, China; Melbourne Sexual Health Centre, Sydney, NSW, Australia
| | - Michel Segondy
- Pathogenesis and Control of Chronic Infections, INSERM, CHU, University of Montpellier, Montpellier, France
| | - Simbarashe Chinyowa
- Department of Surgery, College of Health Sciences University of Zimbabwe, Harare, Zimbabwe
| | - Catharina J Alberts
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
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7
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Liu Y, McCluggage WG, Darragh TM, Zheng W, Roberts JM, Park KJ, Hui P, Blakely M, Sigel K, Gaisa MM. Classifying Anal Intraepithelial Neoplasia 2 Based on LAST Recommendations. Am J Clin Pathol 2021; 155:845-852. [PMID: 33210115 DOI: 10.1093/ajcp/aqaa188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The Lower Anogenital Squamous Terminology (LAST) recommendations classify human papillomavirus-associated squamous lesions into low- and high-grade squamous intraepithelial lesions (LSILs/HSILs). Our study aimed to assess interobserver agreement among 6 experienced pathologists in assigning 40 anal lesions previously diagnosed as anal intraepithelial neoplasia 2 (AIN 2) to either HSIL or non-HSIL categories. METHODS Agreement based on photomicrographs of H&E alone or H&E plus p16 immunohistochemistry was calculated using κ coefficients. RESULTS Agreement was fair based on H&E alone (κ = 0.42; 95% confidence interval [CI], 0.34-0.52). Adding p16 improved agreement to moderate (κ = 0.55; 95% CI, 0.54-0.62). On final diagnosis, 21 cases (53%) had unanimous diagnoses, and 19 (47%) were divided. When designating p16 results as positive or negative, agreement was excellent (κ = 0.92; 95% CI, 0.83-0.95). Among variables (staining location, extent, and intensity), staining of the basal/parabasal layers was a consistent feature in cases with consensus for positive results (20/20). Of the 67 H&E diagnoses with conflicting p16 results, participants modified 32 (48%), downgrading 23 HSILs and upgrading 9 non-HSILs. CONCLUSIONS Although p16 increased interobserver agreement, disagreement remained considerable regarding intermediate lesions. p16 expression, particularly if negative, can reduce unwarranted HSIL diagnoses and unnecessary treatment.
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Affiliation(s)
- Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - Teresa M Darragh
- Department of Pathology, University of California, San Francisco
| | - Wenxin Zheng
- Department of Pathology, Obstetrics and Gynecology, Simon Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas
| | - Jennifer M Roberts
- Histopathology and Cytology Departments, Douglass Hanly Moir Pathology, Sydney, Australia
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, CT
| | - Morgan Blakely
- Department of Pathology, University of California, Los Angeles
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael M Gaisa
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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8
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Deshmukh AA, Suk R, Shiels MS, Sonawane K, Nyitray AG, Liu Y, Gaisa MM, Palefsky JM, Sigel K. Recent Trends in Squamous Cell Carcinoma of the Anus Incidence and Mortality in the United States, 2001-2015. J Natl Cancer Inst 2021; 112:829-838. [PMID: 31742639 DOI: 10.1093/jnci/djz219] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/03/2019] [Accepted: 10/31/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Squamous cell carcinoma of the anus (SCCA) incidence is rising in the United States. Study of incidence trends by stage at diagnosis, age-specific and birth cohort patterns, and trends in mortality could provide evidence for a true increase and etiological clues for the increase in incidence. METHODS Using the US Cancer Statistics dataset, we examined trends in SCCA incidence (2001-2015) and mortality (2001-2016) rates. Join-point regression was used to compute annual and average annual percentage change (AAPC). Incidence patterns by 5-year age group and birth cohort were evaluated using incidence rate ratios (IRRs) and age-period-cohort modeling. RESULTS SCCA incidence increased 2.7% per year (95% confidence interval [CI] = 2.1% to 3.3%), with pronounced increases in age groups 50 years and older. Distant-stage SCCA incidence tripled (AAPC = 8.6%, 95% CI = 5.4% to 12.0%, among men and AAPC = 7.5%, 95% CI = 4.8% to 10.2%, among women) and regional-stage SCCA incidence nearly doubled (AAPC = 4.7% for men and women) in both sexes; the AAPC for localized stage was 1.3% (95% CI = 0.6% to 2.0%) in men and 2.3% (95% CI = 1.8% to 2.8%) in women. Compared with adults born circa 1946, recently born black men (born circa 1986) had a nearly fivefold higher risk (IRR = 4.7, 95% CI = 2.1 to 10.2) of SCCA, and the risk doubled among white men (IRR = 2.0, 95% CI = 1.7 to 2.2) and white women (IRR = 2.1, 95% CI = 1.9 to 2.3) born after circa 1960. Anal cancer mortality rates increased 3.1% per year (95% CI = 2.6% to 3.5%) with statistically significant increases in age groups 50 years and older. SCCA incidence-based mortality increased 1.9% annually (95% CI = 0.5% to 3.4%), with a notable (4.9%, 95% CI = 2.4% to 7.3%, per year) rise in adults ages 60-69 years. CONCLUSION The increase in SCCA incidence, particularly advanced-stage disease, and a similar increase in mortality suggest a true increase in the occurrence of SCCA. Future research and improved prevention are urgently needed to mitigate the increasing disease burden.
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Affiliation(s)
| | - Ryan Suk
- Center for Health Services Research and Center for Healthcare Data
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Kalyani Sonawane
- Center for Health Services Research and Center for Healthcare Data
| | - Alan G Nyitray
- Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX
- Clinical Cancer Center/Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
| | | | - Michael M Gaisa
- Department of Pathology (YL) and Division of Infectious Diseases, Department of Medicine
| | - Joel M Palefsky
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Keith Sigel
- Department of General Internal Medicine, Department of Medicine (KSi), Mt. Sinai Icahn School of Medicine, New York, NY
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9
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Ho HE, Peluso MJ, Margus C, Matias Lopes JP, He C, Gaisa MM, Osorio G, Aberg JA, Mullen MP. Clinical Outcomes and Immunologic Characteristics of Coronavirus Disease 2019 in People With Human Immunodeficiency Virus. J Infect Dis 2021; 223:403-408. [PMID: 32601704 PMCID: PMC7337732 DOI: 10.1093/infdis/jiaa380] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/23/2020] [Indexed: 12/15/2022] Open
Abstract
We performed a retrospective study of coronavirus disease 2019 (COVID-19) in people with human immunodeficiency virus (PWH). PWH with COVID-19 demonstrated severe lymphopenia and decreased CD4+ T cell counts. Levels of inflammatory markers, including C-reactive protein, fibrinogen, D-dimer, interleukin 6, interleukin 8, and tumor necrosis factor α were commonly elevated. In all, 19 of 72 hospitalized individuals (26.4%) died and 53 (73.6%) recovered. PWH who died had higher levels of inflammatory markers and more severe lymphopenia than those who recovered. These findings suggest that PWH remain at risk for severe manifestations of COVID-19 despite antiretroviral therapy and that those with increased markers of inflammation and immune dysregulation are at risk for worse outcomes.
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Affiliation(s)
- Hsi-en Ho
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael J Peluso
- University of California, San Francisco, San Francisco, California, USA
| | - Colton Margus
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Chen He
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael M Gaisa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Georgina Osorio
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Judith A Aberg
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael P Mullen
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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10
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Gaisa MM, Sigel KM, Deshmukh AA, Lenskaya V, Chan CA, Silvera R, Winters J, Liu Y. Comparing Anal Cancer Screening Algorithms Using Cytology and HPV DNA Testing in Three High-risk Populations. J Infect Dis 2021; 224:881-888. [PMID: 33388757 DOI: 10.1093/infdis/jiaa801] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/24/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Screening strategies for high-risk human papillomavirus (hrHPV)-associated anal cancer are evolving. This study compares the screening performance of anal cytology to hrHPV DNA testing and two novel cytology/hrHPV cotesting algorithms among three high-risk populations. METHODS Anal cytology, hrHPV DNA testing, and high-resolution anoscopy (HRA)-guided biopsy results were analyzed from 1,837 participants comprising 1,504 HIV-infected men who have sex with men (MSM), 155 HIV-uninfected MSM, and 178 HIV-infected women. Screening performance to detect histological high-grade squamous intraepithelial lesions (HSIL)/cancer was compared between four strategies with distinct HRA referral thresholds: cytology (ASCUS); hrHPV testing (any hrHPV+); algorithm A (benign cytology/HPV16/18+ or ASCUS/hrHPV+); and algorithm B (benign or ASCUS cytology/hrHPV+). RESULTS Histological HSIL/cancer was detected in 756 (41%) participants. Cytology alone had the lowest sensitivity (0.76-0.89) but the highest specificity (0.33-0.36) overall and for each subgroup. Algorithm B was the most sensitive strategy overall (0.97) and for MSM (HIV-infected 0.97; HIV-uninfected 1.00). For HIV-infected women, hrHPV testing and both algorithms yielded higher sensitivity than cytology (0.96, 0.98, and 0.96). Specificity was low for all strategies and subgroups (range 0.16-0.36). CONCLUSIONS Screening algorithms that incoporate cytology and hrHPV testing significantly increased sensitivity and further decreased specificity to detect anal precancer/cancer among high-risk populations.
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Affiliation(s)
- Michael M Gaisa
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith M Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashish A Deshmukh
- Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX, USA
| | - Volha Lenskaya
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Courtney A Chan
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard Silvera
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Winters
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Liu Y, Prasad-Hayes M, Ganz EM, Poggio JL, Lenskaya V, Malcolm T, Deshmukh A, Zheng W, Sigel K, Gaisa MM. HIV-positive women with anal high-grade squamous intraepithelial lesions: a study of 153 cases with long-term anogenital surveillance. Mod Pathol 2020; 33:1589-1594. [PMID: 32152521 DOI: 10.1038/s41379-020-0518-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/10/2023]
Abstract
Women living with HIV (WLHIV) are at increased risk for human papillomavirus (HPV)-associated anal cancer. Given the "field effect" of HPV pathogenesis, some recommend that anal cancer screening should be limited to WLHIV with prior genital disease. This study aimed to characterize the relationship between anal and genital disease in WLHIV in order to better inform anal cancer screening guidelines. We retrospectively studied 153 WLHIV with biopsy-proven anal high-grade squamous intraepithelial lesions (AHSIL) and long-term evaluable cervical/vaginal/vulvar histopathology. Based on the absence or presence of genital HSIL, subjects were categorized as having isolated AHSIL or multicentric HSIL. Demographics, HIV parameters and cervical/anal HPV status were recorded. Chi-square test was used for bivariate analyses. Of 153 WLHIV with AHSIL, 110 (72%) had isolated AHSIL, while 43 (28%) had multicentric HSIL (28 cervical, 16 vulvar, and 8 vaginal HSIL). The median genital surveillance was 8 years (range 1-27). Cervical HPV16/18 infection was associated with multicentric disease (P = 0.001). Overall, 53% of multicentric cases presented genital HSIL preceding AHSIL with median interval 13 years (range 2-23). Paired anal and cervical high-risk HPV results were available for 60 women within 12 months of AHSIL diagnosis: 30 (50%) had anal infection alone, while 30 (50%) had anal/cervical coinfection by 16/18 (15%), non-16/18 (13%), or different types (22%). In conclusion, WLHIV frequently develop AHSILs without pre-existing genital disease or after long latency following a genital HSIL diagnosis. Our findings support anal cancer screening for WLHIV irrespective of prior genital disease.
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Affiliation(s)
- Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Monica Prasad-Hayes
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric M Ganz
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan Lucas Poggio
- Division of Colorectal Surgery, Department of surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Volha Lenskaya
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Threshia Malcolm
- Division of Colorectal Surgery, Department of surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Ashish Deshmukh
- Center for Health Services Research, Department of Management, Policy, and Community Health, UT Health School of Public Health, Houston, TX, USA
| | - Wenxin Zheng
- Department of Pathology, Obstetrics and Gynecology, Simon Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael M Gaisa
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Gaisa MM, Liu Y, Deshmukh AA, Stone KL, Sigel KM. Electrocautery ablation of anal high-grade squamous intraepithelial lesions: Effectiveness and key factors associated with outcomes. Cancer 2020; 126:1470-1479. [PMID: 31977082 DOI: 10.1002/cncr.32581] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/06/2019] [Accepted: 05/16/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Electrocautery ablation (EA) is a common treatment modality for patients with anal high-grade squamous intraepithelial lesions (HSILs), but to the authors' knowledge its effectiveness has been understudied. The objective of the current study was to determine ablation outcomes and to identify clinicopathological factors associated with postablation disease recurrence. METHODS A total of 330 people living with HIV with de novo intra-anal HSIL who were treated with EA from 2009 to 2016 were studied retrospectively. Using long-term, surveillance high-resolution anoscopy biopsy data, treatment failures were classified as local recurrence (HSIL noted at the treated site at the time of surveillance) or overall recurrence (HSIL noted at treated or untreated sites). The associations between these outcomes and clinical factors were analyzed using Cox proportional hazards models. RESULTS Approximately 88% of participants were men who have sex with men. The median age of study participants was 45.5 years (range, 35-51 years) and approximately 49% had multiple index HSILs (range, 2-6 index HSILs). At a median of 12.2 months postablation (range, 6.3-20.9 months postablation), approximately 45% of participants had developed local recurrence whereas 60% had developed overall recurrence. Current cigarette smoking, HIV viremia (HIV-1 RNA ≥100 copies/mL), and multiple index HSILs were found to be predictive of local recurrence. Overall recurrence was more common in current smokers and those with multiple index lesions. In multivariable models that included human papillomavirus (HPV) genotypes, baseline and persistent infections with HPV-16 and/or HPV-18 were found to be significantly associated with both local and overall recurrence. CONCLUSIONS EA is an effective treatment modality for anal HSIL in people living with HIV, but rates of disease recurrence are substantial. Multiple index HSILs, HIV viremia, current cigarette smoking, and both baseline and persistent infection with HPV-16 and/or HPV-18 appear to negatively impact treatment success. Ongoing surveillance is imperative to capture recurrence early and improve long-term treatment outcomes.
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Affiliation(s)
- Michael M Gaisa
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ashish A Deshmukh
- Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston, Texas
| | - Kimberly L Stone
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keith M Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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13
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Wang Y, Wang Y, Gaisa MM, Sigel K, Zheng W, Liu Y, Wang Y. Negative Predictive Value of Human Papillomavirus Testing: Implications for Anal Cancer Screening in People Living with HIV/AIDS. J Oncol 2020; 2020:6352315. [PMID: 32411239 PMCID: PMC7204264 DOI: 10.1155/2020/6352315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/07/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES People living with HIV/AIDS (PLWHA) have an increased incidence of anal squamous cell carcinoma. Since high-risk human papillomavirus (hrHPV) is the primary cause, hrHPV DNA testing may play an important role in anal cancer screening. This study aims to determine the negative predictive value (NPV) of hrHPV testing in PLWHA as well as factors that may lead to false-negative results. METHODS Anal swabs were collected for cytology and Cobas® 4800 HPV test for 14 hrHPV types. Patients underwent concomitant high-resolution anoscopy (HRA) examination and biopsy. High-grade squamous intraepithelial lesions (HSIL, synonymous with anal intraepithelial neoplasia AIN2 and 3) detected in Cobas-negative patients were genotyped for 22 HPV types using BioPerfectus Multiplex Real-time PCR. RESULTS 156 PLWHA tested negative for hrHPV on anal swab samples (i.e., Cobas-negative). HRA-guided biopsy detected HSIL/AIN3 in 13 patients (8%, NPV 92%), HSIL/AIN2 in 5 patients (3%), low-grade squamous intraepithelial lesions in 82 (LSIL, 53%), or benign findings in 56 (36%). No cancer was found. The HSIL group was similar to the LSIL/benign group regarding age, gender, race/ethnicity, clinical HIV parameters, cytological diagnoses, history of receptive anal sex, and smoking (p ≥ 0.02). Genotyping HSIL tissue derived from Cobas-negative patients revealed hrHPV (n=7), possibly carcinogenic HPV53, 67, 73, 82 (n=12), or absence of hrHPV (n=4). CONCLUSIONS In this series, anal hrHPV DNA testing offered 92% NPV for PLWHA; in other words, a 8% risk of occult precancer remains for those who test hrHPV negative on anal swab samples.
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Affiliation(s)
- Yiying Wang
- Department of Obstetrics and Gynecology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, China
| | - Yan Wang
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael M. Gaisa
- Department of Medicine, Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith Sigel
- Department of Medicine, Division of General Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wenxin Zheng
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Obstetrics and Gynecology, Simons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yue Wang
- Department of Obstetrics and Gynecology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, China
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14
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Jacobson KB, Gaisa MM, Sigel K, Foster AL, Fierer DS. Anal Dysplasia in Human Immunodeficiency Virus-Infected Men Who Have Sex With Men With Sexually Acquired Early Hepatitis C Virus Infection. Open Forum Infect Dis 2019; 6:ofz339. [PMID: 31777754 PMCID: PMC6876538 DOI: 10.1093/ofid/ofz339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/12/2019] [Indexed: 11/15/2022] Open
Abstract
Background Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at increased risk of anorectal infection with high-risk human papillomavirus and subsequent high-grade squamous intraepithelial lesions (HSIL), the putative precursor to anal cancer. Recently, an epidemic of sexually transmitted hepatitis C virus (HCV) has emerged that shares this anorectal route of transmission. We hypothesized that the prevalence of anal HSIL would be high in HIV-infected MSM with sexually acquired early HCV infection. Methods High-resolution anoscopy (HRA) findings from a cohort of HIV-infected MSM with sexually acquired early HCV infection were compared with HRA findings from a contemporary cohort of HIV-infected MSM without HCV infection who underwent HRA due to abnormal anal cytology found during routine screening. Results Sixty HIV-infected MSM with sexually acquired early HCV infection and the comparator group of 1150 HIV-infected MSM with abnormal anal cytology but without HCV underwent HRA. The HIV-infected MSM with sexually acquired early HCV had higher CD4 counts compared with the comparator group (656 and 541 cells/μL, respectively; P = .02). Despite this, the prevalence of anal dysplasia was as high among MSM with early HCV as in the comparator group of MSM with abnormal cytology (47 [78%] and 941 [82%], respectively; P = .50), as was the proportion with HSIL (25 [42%] and 379 [33%], respectively; P = .17). Conclusions The prevalence of anal dysplasia in HIV-infected MSM with sexually acquired early HCV infection was as high as that of HIV-infected MSM with abnormal anal cytology. These findings suggest that primary screening with HRA may be warranted for HIV-infected MSM with early HCV.
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Affiliation(s)
- Karen B Jacobson
- Division of Infectious Diseases, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael M Gaisa
- Division of Infectious Diseases, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keith Sigel
- Division of Infectious Diseases, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrew L Foster
- Division of Infectious Diseases, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel S Fierer
- Division of Infectious Diseases, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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15
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Liu Y, Sigel K, Gaisa MM. Human Papillomavirus Genotypes Predict Progression of Anal Low-Grade Squamous Intraepithelial Lesions. J Infect Dis 2019; 218:1746-1752. [PMID: 30053247 DOI: 10.1093/infdis/jiy463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/20/2018] [Indexed: 01/10/2023] Open
Abstract
Background High-risk human papillomavirus (hrHPV)-induced anal low-grade squamous intraepithelial lesions (LSILs) have the potential to progress to high-grade squamous intraepithelial lesions (HSILs). We investigated whether anal hrHPV infections, particularly types 16 and 18, predict LSIL-to-HSIL progression. Methods One hundred forty-six human immunodeficiency virus (HIV)-infected and 22 HIV-uninfected patients with anal LSILs underwent cytology, HPV genotyping (16, 18, and pooled 12 hrHPV types), and high-resolution anoscopy-guided biopsy at baseline and surveillance. The associations between the rate of LSIL-to-HSIL progression and HPV types as well as longitudinal HPV-16/18 status were assessed by fitting separate Cox regression models. Results At baseline, 91% of patients harbored hrHPV: HPV-16/18 (44%) and non-16/18 (86%). Upon follow-up (median, 20 [range, 6-36] months), 41% developed HSIL (84% at the same anatomic location as the initial LSIL and 16% at a different location). Baseline HPV-16/18-positive patients had greater probability of progression than patients with non-16/18 types or negative (67%, 25%, and 7%, respectively; P < .001). Persistent HPV-16/18 conferred the highest probability of progression (70%), followed by intermittent HPV-16/18 positivity (52%). In unadjusted and adjusted analyses, baseline and persistent HPV-16/18 were significantly associated with LSIL-to-HSIL progression. Conclusions Anal LSIL patients who are positive for hrHPV, especially HPV-16/18, have an increased risk of developing HSIL. Type-specific HPV testing could serve as a risk stratification tool, providing prognostic information.
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Affiliation(s)
- Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keith Sigel
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael M Gaisa
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
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Liu Y, Gaisa MM, Wang X, Swartz TH, Arens Y, Dresser KA, Sigel C, Sigel K. Differences in the Immune Microenvironment of Anal Cancer Precursors by HIV Status and Association With Ablation Outcomes. J Infect Dis 2019; 217:703-709. [PMID: 28968881 DOI: 10.1093/infdis/jix454] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/30/2017] [Indexed: 01/20/2023] Open
Abstract
Background Anal high-grade squamous intraepithelial lesions (HSILs) are the precursors to anal cancer and frequently persist or recur following electrocautery ablation (EA). Impaired mucosal immunity may facilitate anal carcinogenesis. We characterized the immune microenvironment of anal HSILs in correlation with human immunodeficiency virus (HIV) serostatus and ablation outcomes. Methods Using immunohistochemistry, mucosa-infiltrating CD4+ and CD8+ lymphocytes were quantified in HSILs and benign mucosa from 70 HIV+ and 45 HIV- patients. Clinicopathological parameters were compared. Results Anal HSILs harbored more T lymphocytes than benign mucosa regardless of HIV status (P ≤ .03). Total T lymphocyte count and CD8+ subset were significantly higher in HIV+ HSILs versus HIV- HSILs (median cell count, 71 vs 47; 47 vs 22/high power field [HPF]; P < .001), whereas the CD4+ subset was comparable between groups (median, 24 vs. 25; P = .40). Post EA, HSILs persisted in 41% of HIV+ and 19% of HIV- patients (P = .04). Unadjusted analysis showed trends toward EA failures associated with HIV seropositivity (incidence rate ratio [IRR], 2.0; 95% CI, .8-4.9) and increased CD8+ cells (IRR, 2.3; 95% CI, .9-5.3). Conclusions Human immunodeficiency virus is associated with alterations of the immune microenvironment of anal HSILs manifested by increased local lymphocytic infiltrates, predominately CD8+. Human immunodeficiency virus seropositivity and excess mucosa-infiltrating CD8+ cells may be associated with ablation resistance.
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Affiliation(s)
- Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai
| | - Michael M Gaisa
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai
| | - Xiaofei Wang
- Department of Pathology, University of Massachusetts Medical School, Worcester
| | - Talia H Swartz
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai
| | - Yotam Arens
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
| | - Karen A Dresser
- Department of Pathology, University of Massachusetts Medical School, Worcester
| | - Carlie Sigel
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Keith Sigel
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
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Liu Y, Sigel K, Gaisa MM. Electrocautery ablation of anal HSIL: correlation of treatment outcomes with histological features and HPV genotypes. Papillomavirus Research 2018. [DOI: 10.1016/j.pvr.2018.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Liu Y, Sigel K, Gaisa MM. Biomarker P16 Predicts Progression Risk of Anal Low-grade Squamous Intraepithelial Lesions. Papillomavirus Research 2018. [DOI: 10.1016/j.pvr.2018.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Liu Y, Sigel K, Gaisa MM. Ablation Outcomes for HIV-Infected and Uninfected Patients with Anal High-grade Squamous Intraepithelial Lesions (HSIL). Papillomavirus Research 2018. [DOI: 10.1016/j.pvr.2018.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Liu Y, Wang X, Kalir T, Chhieng D, Sigel K, Gaisa MM. Anal High-Grade Squamous Intraepithelial Lesions in Human Immunodeficiency Virus-Infected Men: A Study of 100 Cases With Emphasis on Cytohistologic Correlation. Am J Clin Pathol 2017; 147:315-321. [PMID: 28395054 DOI: 10.1093/ajcp/aqw229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Anorectal cytology (ARC) is a widely used screening tool for anal cancer in human immunodeficiency virus (HIV)-infected men who have sex with men (MSM). Its diagnostic accuracy needs to be improved, especially for high-grade squamous intraepithelial lesions (HSILs). METHODS Using 100 HIV+ MSM with biopsy-proven anal HSILs, we correlated histologic/cytologic findings. RESULTS Upon review, HSIL cells were present in 58 cytology samples and absent in 42. Positive samples were higher in cellularity and contained transformation zones ( P < .05). Cytology was able to predict HSILs in 36%, 48%, 68%, and 78% of patients with one, two, three, and four or more high-grade lesions. HSIL cells were identified in all cytology samples initially reported as HSILs or atypical squamous cells, cannot exclude HSIL and in 34 samples reported as low-grade squamous intraepithelial lesions or less. Notably, among this last category, 15 (44%) were keratinized-type HSILs. CONCLUSIONS Our findings should improve the ARC detection rate for anal HSILs, helping to implement ARC as the primary screening tool for anal cancer.
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Affiliation(s)
- Yuxin Liu
- From the Division of Gynecologic Pathology
| | - Xiaofei Wang
- Division of Cytology, Department of Pathology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester
| | | | | | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY
| | - Michael M Gaisa
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY
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Foster AL, Gaisa MM, Hijdra RM, Turner SS, Morey TJ, Jacobson KB, Fierer DS. Shedding of Hepatitis C Virus Into the Rectum of HIV-infected Men Who Have Sex With Men. Clin Infect Dis 2016; 64:284-288. [PMID: 28013267 DOI: 10.1093/cid/ciw740] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/07/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND For over a decade we have known of an epidemic of sexually transmitted hepatitis C virus (HCV) infection among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM), but there still remains significant controversy over which bodily fluid(s) are responsible for HCV transmission in these men. METHODS We enrolled HIV-infected MSM with recent and chronic HCV infection and quantified HCV from rectal fluid obtained by blind swab. We compared the rectal HCV viral load (VL) with paired blood HCV VL. RESULTS We found rectal HCV shedding in 20 (47%) of 43 men, only one (2%) of whom had visible bleeding. Detection of rectal HCV shedding was associated with blood VL > 5 log10 IU/mL (p = .01), and 85% with blood VL > 5 log10 IU/mL had rectal shedding. The HCV VL of the rectal fluid ranged from 2.6 to 5.5 log10 IU/mL. Based on the median rectal fluid VL, the surface of an average human penis would be exposed to at least 2,300 IU of HCV for the duration of anal intercourse. CONCLUSION This study provides the first direct evidence to our knowledge that a sufficient quantity of HCV is shed into the rectum in HIV-infected men with HCV infection to directly infect an inserted penis or be passed indirectly through fomite-like transmission to the rectum of sex partner. We must develop an appropriate public health campaign to educate MSM about these routes of HCV infection to reverse the HCV epidemic among HIV-infected MSM.
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Affiliation(s)
- Andrew L Foster
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael M Gaisa
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rosanne M Hijdra
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samuel S Turner
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tristan J Morey
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen B Jacobson
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel S Fierer
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
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Gaisa MM, Goldstone SE. Diagnosis and Treatment of Anal Intraepithelial Neoplasia and Condylomata. Seminars in Colon and Rectal Surgery 2011. [DOI: 10.1053/j.scrs.2010.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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