Clarisse Dupin1, Laurent Siproudhis2, Sébastien Henno3, Sophie Minjolle1, Cédric Arvieux4, Pierre Tattevin4. 1. Department of Virology, Pontchaillou University Hospital, Rennes, France; Université Rennes-I, Rennes, France. 2. Université Rennes-I, Rennes, France; Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France. Electronic address: laurent.siproudhis@chu-rennes.fr. 3. Université Rennes-I, Rennes, France; Department of Pathology, Pontchaillou University Hospital, Rennes, France. 4. Université Rennes-I, Rennes, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.
Abstract
BACKGROUND: Screening for anal dysplasia in human immunodeficiency virus (HIV)-infected patients is not standardized. High-resolution imaging is not adequate for mass screening, and anal cytology requires expertise. New biomarkers, selected because of their use in cervical cancer mass screening, have been originally tested for targeted and easy-to-perform screening. METHODS: 120 HIV-infected individuals (males 96.4%, mean age 47±11 years) were referred for clinical examination, anoscopy, and cytological studies on anal swab. Dysplasia grading, Human Papilloma Virus genotyping, E6/E7mRNA detection and p16(INK4A)/Ki-67 immunostaining were performed. High-grade lesions were histologically confirmed by anal biopsies after high-resolution anoscopy. RESULTS: Among the 120 anal swabs analyzed, 36 (30%) had low grade and 6 (5%) had high-grade lesions. Virus genotype was identified in 88 patients (73.3%), and 77 (64.2%) were positive for high-risk genotype(s). High-risk genotype was associated to low-grade or high-grade lesions with a sensitivity of 0.93 and a specificity of 0.51. For E6/E7mRNA, sensitivity and specificity for low-grade and high-grade lesions were, respectively, 0.88 and 0.78. Combination of genotyping, E6/E7mRNA and p16(INK4A)/Ki-67 appropriately ruled out dysplasia in 55% of patients. CONCLUSIONS: Three routine biomarkers may avoid unnecessary invasive procedures with the perspective of an improvement of patient compliance. A decision making algorithm, based on the combination of these three biomarkers, is proposed.
BACKGROUND: Screening for anal dysplasia in human immunodeficiency virus (HIV)-infectedpatients is not standardized. High-resolution imaging is not adequate for mass screening, and anal cytology requires expertise. New biomarkers, selected because of their use in cervical cancer mass screening, have been originally tested for targeted and easy-to-perform screening. METHODS: 120 HIV-infected individuals (males 96.4%, mean age 47±11 years) were referred for clinical examination, anoscopy, and cytological studies on anal swab. Dysplasia grading, Human Papilloma Virus genotyping, E6/E7mRNA detection and p16(INK4A)/Ki-67 immunostaining were performed. High-grade lesions were histologically confirmed by anal biopsies after high-resolution anoscopy. RESULTS: Among the 120 anal swabs analyzed, 36 (30%) had low grade and 6 (5%) had high-grade lesions. Virus genotype was identified in 88 patients (73.3%), and 77 (64.2%) were positive for high-risk genotype(s). High-risk genotype was associated to low-grade or high-grade lesions with a sensitivity of 0.93 and a specificity of 0.51. For E6/E7mRNA, sensitivity and specificity for low-grade and high-grade lesions were, respectively, 0.88 and 0.78. Combination of genotyping, E6/E7mRNA and p16(INK4A)/Ki-67 appropriately ruled out dysplasia in 55% of patients. CONCLUSIONS: Three routine biomarkers may avoid unnecessary invasive procedures with the perspective of an improvement of patient compliance. A decision making algorithm, based on the combination of these three biomarkers, is proposed.
Authors: Fernando Dias Gonçalves Lima; Janine D Viset; Mariska M G Leeflang; Jacqueline Limpens; Jan M Prins; Henry J C de Vries Journal: Open Forum Infect Dis Date: 2019-04-16 Impact factor: 3.835
Authors: Sergio Serrano-Villar; Beatriz Hernández-Novoa; Amparo de Benito; Jorge Del Romero; Antonio Ocampo; José Ramón Blanco; Mar Masiá; Elena Sendagorta; Gonzalo Sanz; Santiago Moreno; José A Pérez-Molina Journal: PLoS One Date: 2017-11-30 Impact factor: 3.240