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| |  Better Anal Cytology Screening Practices Needed for HIV-Infected Youth: Presented at PAS By Jill Stein BALTIMORE, Md -- May 4, 2009 -- Investigators are calling for improvements in screening guidelines for anal dysplasia in HIV-infected youth, according to research presented here at the 2009 Pediatric Academic Societies (PAS) Annual Meeting. They are also calling for the training of individuals who conduct screenings in this population. The push for improved guidelines was made here on May 3 by George K. Siberry, MD, Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development/National Institutes of Health, Bethesda, Maryland. Dr. Siberry and a team of colleagues evaluated anal dysplasia screening practices using data from a Centers for Disease Control-sponsored observational cohort of HIV-infected children and youth from numerous US centres. The cohort, Longitudinal Epidemiologic Study to Gain Insight Into HIV and AIDS in Children and Youth (LEGACY), included patients aged 13 to 24 years with more than 1 clinic visit in 2006 at sites with more than 10 patients. The investigators found a high rate of abnormal anal Papanicolaou (AP) screenings for anal cytology, a broad range in AP screening rates, and gender-based differences in AP screening. "HPV [human papillomavirus] infection of the anal canal can lead to anal dysplasia and cancer, and the rates of anal HPV infection and anal cancer appear to be increasing in HIV-infected men and women," the authors wrote in their poster presentation. "Early detection of anal dysplasia may decrease anal cancer, but there are no official US guidelines for AP screening for abnormal cytology," the investigators added. In addition, not much is known about the approach to screening for anal dysplasia in HIV-infected youth. Of 17 eligible sites, 4 (24%) performed at least 1 AP screening on any patient. According to a comparison of sites that performed AP screening (AP sites) with sites that did not perform AP screening (non-AP site), site-specific AP rates ranged from 2% to 37% of patients. Sites caring for higher proportions of youth who acquired HIV "behaviourally" were more likely to perform AP screening. Of 801 total subjects, 32 (4%) had more than 1 AP screening; of these patients, 10 (31%) had multiple AP screenings (range: 2 to 4 screenings; median: 2 screenings). Within sites performing AP screenings, subjects were more likely to have had an AP screening if they were sexually active, had undergone cervical cytologic examination, had another sexually transmitted disease, had a higher CD4 percentage, or were defined as CDC Pediatric HIV Clinical Category A (40% vs 16%) (all P < .01). Sites in this sample performed AP screening either exclusively in males or exclusively in females. This finding highlights the need for clearer guidelines on AP screening, the investigators said. While no anal cancer was detected, more than 40% of AP screenings performed were abnormal, suggesting that too few youth are being screened with AP tests. Dr. Siberry and colleagues noted that the outcome of abnormal anal cytology over time in this population is not well defined and requires further study.
[Presentation title: Anal Cytology Screening Practices in HIV-Infected Youth in the LEGACY Cohort. Abstract 3865.240]
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