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Peer-reviewedCC BYInternational Journal of Medical Microbiology

Human papillomavirus oncogene mRNA testing for anal dysplasia and anal cancer screening in men living with HIV

  • Steffi Silling1
  • Alexander Kreuter2
  • Anja Potthoff3
  • Frank Oellig4
  • Martin Hellmich5
  • Ulrike Wieland6
6 affiliations
  1. 1Institute of Virology, National Reference Center for Papilloma, and Polyomaviruses, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
  2. 2Department of Dermatology, Venereology, and Allergology, Helios St. Elisabeth Hospital Oberhausen, University Witten-Herdecke, Oberhausen, Germany
  3. 3WIR – Walk in Ruhr, Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Bochum, Germany
  4. 4Institute of Pathology, Mülheim an der Ruhr, Germany
  5. 5Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
  6. 6Institute of Virology, National Reference Center for Papilloma, and Polyomaviruses, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany; Correspondence to: Institute of Virology, University Hospital Cologne, Fuerst-Pueckler-Str. 56, Koeln 50935, Germany.
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Abstract

Background: Anal human papillomavirus (HPV)-induced high-grade squamous intraepithelial lesions (HSIL) are very frequent in men who have sex with men living with HIV (MSMLWH). Anal cancer screening is recommended for MSMLWH. This study aimed to evaluate the diagnostic accuracy of high-risk (hr)-HPV oncogene-mRNA testing for the detection of HSIL/anal cancer (HSIL+) in MSMLWH. Methods: 3204 intraanal swabs were collected from 865 MSMLWH participating in an anal cancer screening programme including anal cytology/histology, high-resolution anoscopy, and HPV-DNA-typing between 2010 and 2023. Hr-HPV-mRNA and hr-HPV-DNA analyses were performed on 865 baseline swabs. HSIL-free survival up to 96 months was estimated stratified by hr-HPV-mRNA status at baseline. Results: For the detection of HSIL+, sensitivity, negative predictive value, and positive predictive value were similar for hr-HPV-mRNA (92.4%, 95.3%, 26.9%) and hr-HPV-DNA testing (88.9%, 90.7% 23.0%). Specificity was significantly higher for hr-HPV-mRNA (38.0%, 95%CI 34.4–41.8) compared to hr-HPV-DNA (26.7%, 95%CI 23.4–30.1) testing. A negative hr-HPV-mRNA result at baseline was associated with HSIL-free survival (p < 0.001; hazard ratio (HR) 3.26, 95%CI 2.29–4.65; median follow-up time 43.0 months), regardless of cytology/histology results at baseline. Among participants with normal cytology, 93.3% of those with a negative hr-HPV-mRNA result were HSIL-free after 60 months, compared to 65.0% of those with a positive hr-HPV-mRNA result (p < 0.001). Conclusions: Hr-HPV-mRNA testing has increased specificity and similar sensitivity for the detection of HSIL+ in MSMLWH compared to hr-HPV-DNA-testing. Hr-HPV-mRNA testing has the potential to improve anal cancer screening effectiveness. Negative hr-HPV-mRNA results could allow for a safe extension of screening intervals.

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Cite

BibTeXRIS
BibTeX
@article{silling2026human,
  title = {{Human papillomavirus oncogene mRNA testing for anal dysplasia and anal cancer screening in men living with HIV}},
  author = {Steffi Silling and Alexander Kreuter and Anja Potthoff and Frank Oellig and Martin Hellmich and Ulrike Wieland},
  journal = {International Journal of Medical Microbiology},
  year = {2026},
  month = oct,
  doi = {10.1016/j.ijmm.2026.151751},
  url = {https://doi.org/10.1016/j.ijmm.2026.151751},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Human papillomavirus oncogene mRNA testing for anal dysplasia and anal cancer screening in men living with HIV
AU  - Steffi Silling
AU  - Alexander Kreuter
AU  - Anja Potthoff
AU  - Frank Oellig
AU  - Martin Hellmich
AU  - Ulrike Wieland
PY  - 2026
DA  - 2026/10/30
JO  - International Journal of Medical Microbiology
DO  - 10.1016/j.ijmm.2026.151751
UR  - https://doi.org/10.1016/j.ijmm.2026.151751
AB  - Background: Anal human papillomavirus (HPV)-induced high-grade squamous intraepithelial lesions (HSIL) are very frequent in men who have sex with men living with HIV (MSMLWH). Anal cancer screening is recommended for MSMLWH. This study aimed to evaluate the diagnostic accuracy of high-risk (hr)-HPV oncogene-mRNA testing for the detection of HSIL/anal cancer (HSIL+) in MSMLWH. Methods: 3204 intraanal swabs were collected from 865 MSMLWH participating in an anal cancer screening programme including anal cytology/histology, high-resolution anoscopy, and HPV-DNA-typing between 2010 and 2023. Hr-HPV-mRNA and hr-HPV-DNA analyses were performed on 865 baseline swabs. HSIL-free survival up to 96 months was estimated stratified by hr-HPV-mRNA status at baseline. Results: For the detection of HSIL+, sensitivity, negative predictive value, and positive predictive value were similar for hr-HPV-mRNA (92.4%, 95.3%, 26.9%) and hr-HPV-DNA testing (88.9%, 90.7% 23.0%). Specificity was significantly higher for hr-HPV-mRNA (38.0%, 95%CI 34.4–41.8) compared to hr-HPV-DNA (26.7%, 95%CI 23.4–30.1) testing. A negative hr-HPV-mRNA result at baseline was associated with HSIL-free survival (p < 0.001; hazard ratio (HR) 3.26, 95%CI 2.29–4.65; median follow-up time 43.0 months), regardless of cytology/histology results at baseline. Among participants with normal cytology, 93.3% of those with a negative hr-HPV-mRNA result were HSIL-free after 60 months, compared to 65.0% of those with a positive hr-HPV-mRNA result (p < 0.001). Conclusions: Hr-HPV-mRNA testing has increased specificity and similar sensitivity for the detection of HSIL+ in MSMLWH compared to hr-HPV-DNA-testing. Hr-HPV-mRNA testing has the potential to improve anal cancer screening effectiveness. Negative hr-HPV-mRNA results could allow for a safe extension of screening intervals.
SN  - 1438-4221
SN  - 1618-0607
ER  -