Interest of cytology combined with Xpert®HPV and Anyplex®II HPV 28 Detection human papillomavirus (HPV) typing: differential profiles of anal and cervical HPV lesions in HIV‐infected patients on antiretroviral therapy

Abstract

Objectives: The aim of the study was to assess the interest to combine cytological examination and human papillomavirus (HPV) typing of anal and cervical Papanicolaou (Pap) smears of HIV‐infected patients on combination antiretroviral therapy (cART), to evaluate whether differences in prevalence exist between anal and cervical squamous intraepithelial lesions in patients with high‐risk oncogenic HPV infection. Methods: Anal and/or cervical Pap smears were obtained by anoscopy and/or colposcopy in 238 subjects recruited consecutively in 2015: anal smears were obtained from 48 male and female patients [42 men; 35 men who have sex with men (MSM)] and cervical smears from 190 female patients. Cytological Bethesda classification was coupled with HPV typing. HPV typing was performed, on the same smears, using the Xpert® HPV Assay, which detects only high‐risk HPV (hr HPV), and the Anyplex® II HPV 28 Detection assay, which detects hr HPV and low‐risk (lr) HPV. Results: Our data showed clear‐cut differences between the anal and cervical samples. Compared with the cervical samples, the anal samples exhibited (1) more numerous cytological lesions, which were histologically proven; (2) a higher hr HPV infection prevalence; (3) a higher prevalence of multiple hr HPV coinfections whatever HPV typing kit was used; (4) a predominance of HPV 16 and HPV 18/45 types. Overall, there was an almost perfect agreement between the two HPV typing assays (absolute agreement = 90.3%). Conclusions: Co‐testing consisting of cytology and HPV typing is a useful screening tool in the HIV‐infected population on cART. It allows detection of prevalence differences between anal and cervical HPV‐related lesions. As recently recommended, anal examination should be regularly performed especially in HIV‐infected MSM but also in HIV‐infected women with genital hr HPV lesions.