EATG » HPV Biomarkers Predict Risk for Anal Precancer in MSM and Who Have HIV

HPV Biomarkers Predict Risk for Anal Precancer in MSM and Who Have HIV

Among men who have HIV who also have sex with men (MSM), human papillomavirus (HPV)-related biomarkers provide long-term risk stratification for anal precancers, according to results published in Clinical Infectious Diseases.

The results showed that testing negative on high-risk HPV and dual stain indicated a low risk for high-grade squamous intraepithelial lesion (HSIL) and anal intraepithelial neoplasia grade 2 or more severe diagnoses (HSIL/AIN2+).

The study included MSM who also had been diagnosed with HIV between 2009 and 2010, with passive follow-up through 2015 (n=363). Participants had anal cytology and high-resolution anoscopy at baseline. The researchers calculated the baseline sensitivity and specificity for each biomarker for a combined end point of HSIL/AIN2+. They also estimated the 2- and 5-year cumulative risks for HSIL/AIN2+ using logistic and Cox regression models.

During the study, 129 men were diagnosed with HSIL/AIN2+.

The researchers found that high-risk HPV testing had the highest positivity (36.6%, 95% CI, 32.9%-54.8%) and sensitivity (100%) of all assays, but it also had the lowest specificity (29.4%). They also found that HPV16/18 genotyping and HPV E6/E7 mRNA both had high specificity but low sensitivity.

The results indicated that 2- and 5-year risks for HSIL/AIN2+ were highest for those who tested positive for HPV16/18 or HPV E6/E7 mRNA followed by those who tested positive on dual stain. Those who tested negative on high-risk-HPV or dual stain had the lowest 2- and 5-year risks for HSIL/AIN2+.

“Screening with p16/Ki-67 dual stain may provide greater reassurance against anal precancer compared to cytology, or at a higher threshold of positivity, may reduce the number of [MSM who also have HIV] who need further evaluation,” the researchers wrote.

By Hannah Dellabella


Clarke MA, Cheung LC, Lorey T, et al. Five-year prospective evaluation of cytology, HPV testing, and biomarkers for detection of anal precancer in HIV+ MSM [published online November 12, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy970