Background: Human Papillomavirus (HPV) causes anogenital warts and anal cancer. Anal cancer screening is recommended for men who have sex with men (MSM) and Human Immunodeficiency Virus (HIV) patients.
Objectives: To determine risk factors associated with an abnormal screening anal Papanicolaou (Pap) smear among MSM patients.
Methods: A retrospective review of computerized medical charts of patients in whom an anal Pap was done at an urban community health center from April to June 2009 was performed. An abnormal Pap was defined as at least Atypical Squamous Cells of Undetermined Significance.
Results: 86 MSM had screening Pap performed; 48 (56%) were HIV positive. Mean duration of HIV diagnosis was 6 years and mean CD4 count 580/mm3. An abnormal Pap was detected among 56% of HIV positive and 36% of HIV negative. Among HIV positive patients prior hepatitis B exposure (positive hepatitis B core antibody) was detected in 19% (5 patients) of those with an abnormal Pap compared to none with a normal Pap. Of those 5 patients, one was hepatitis surface antigen positive and only one was vaccinated. 59% of HIV patients with abnormal Pap were vaccinated and one had positive hepatitis surface antigen. After multivariable adjustment, only prior exposure to hepatitis B in HIV patients was independently associated with an abnormal Pap (P=0.037). There was no association with age, smoking and number of sexual partners. In addition, only 5% of those meeting criteria for anal cancer screening were tested.
Conclusions: These preliminary findings suggest that prior hepatitis B exposure may identify a subgroup of HIV positive MSM at high risk for an abnormal anal Pap.
Implications for Programs, Policy, and/or Research: Screening efforts may need to be maximized this high risk group. Further research is needed to elucidate barriers to anal cancer screening given the low proportion of eligible patients screened during the study period.