HPV16 L1 in PLWH

Evidence before the study With anal cancer incidence rising, professional societies have issued guidelines recommending regular anal screening across high-risk populations, most notably people living with HIV (PLWH). Current screening methods include sampling cells using anal swabs, eliciting ‘shame’ (consent is sub-optimal) and error (results depend on sampling a region). Recently, we demonstrated that a novel blood-based rapid test for antibodies against HPV16-L1 enables detection of HPV16-induced cancers with high specificity and sensitivity. However, performance in detecting pre-cancerous lesions has not been evaluated to date. Added value of this study This study describes the first investigation of a serological marker in anal cancer screening, and demonstrates for the first time a relationship between serum HPV16-L1 antibody levels and anal dysplasia in PLWH. Our results demonstrate concordance between serology and anal cytology, with serological assay sensitivity particularly high for high grade anal dysplasia. Implications of all the available evidence Blood-based testing for antibodies against HPV16-L1 potentially offers a non-invasive, cost-effective, easy-to-use additional tool for anal dysplasia screening. Serum testing could be easily integrated into current routine visits of PLWH without requiring additional equipment, invasive procedures or specialist training. In settings where regular proctologic assessments are non-feasible or refused by the patients, blood-based testing may enhance compliance with current recommendations for regular screening