{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:03:46Z","timestamp":1789391026414,"version":"build-2803163510"},"reference-count":10,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"YL","award":["K23AI197966"],"award-info":[{"award-number":["K23AI197966"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J STD AIDS"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Human Papilloma Virus (HPV)-related high-grade anal intraepithelial neoplasia (AIN) is the precursor of anal cancer. There are limited data identifying factors that influence AIN progression in adults eligible for HPV vaccines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single-center cohort study including persons aged 18-45 years as of 2020 followed at the University of Pittsburgh Medical Center Anal Dysplasia Clinic (January 2020-December 2024), each with at least one anal cytology paired with histopathology or high-resolution anoscopy (reference standard). A subset with an initial non-HSIL result and \u22652 visits was followed longitudinally to assess progression to HSIL. Logistic regression identified factors associated with HSIL; Cox proportional hazards regression assessed progression to HSIL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 238 individuals (191 with HIV and 47 without), with median age 37 years, 16% female sex at birth, and median age at HPV vaccination series initiation of 27 years, with 79 (82%) of vaccinated patients receiving all three doses. Among 507 paired cytology-reference results, anal cytology had low-moderate sensitivity (55%) and specificity (82%), but an acceptable negative predictive value of 96% for HSIL on the reference standard (ref-HSIL). In the full cohort, the risk factor for ref-HSIL was ASC-H (atypical squamous cells, cannot exclude HSIL) or HSIL on cytology (adjusted odds ratio [aOR] 5.95,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). In PWH, lower nadir CD4 count was associated with higher risk of ref-HSIL. Seven individuals with initial non-ref-HSIL progressed to ref-HSIL, all PWH with nadir CD4 &lt;300 cells\/\u00b5l; higher nadir CD4 was protective against progression (adjusted hazard ratio 0.43 per 100 cells\/\u00b5l,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.002) while current smoking was a risk factor (aHR 5.09,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Anal cytology alone is not sensitive for HSIL detection in younger adults. Low nadir CD4 + count and current smoking identify patients needing closer surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09564624261487508","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T13:13:20Z","timestamp":1789132400000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors and cytology performance for high-grade anal intraepithelial neoplasia in young adults: a cohort study"],"prefix":"10.1177","author":[{"given":"Irada","family":"Choudhuri","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Pittsburgh Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Layden","sequence":"additional","affiliation":[{"name":"University of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Baran","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Faaborg","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"McMahon","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh Medical Center"},{"name":"University of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh Medical Center"},{"name":"University of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5300-0571","authenticated-orcid":false,"given":"Yijia","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh Medical Center"},{"name":"University of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.4251\/wjgo.v9.i2.50"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaf073"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2201048"},{"issue":"3","key":"e_1_3_5_5_2","first-page":"257","article-title":"Anal intraepithelial neoplasia: diagnosis, screening, and treatment","volume":"32","author":"Siddharthan RV","year":"2019","unstructured":"Siddharthan RV, Lanciault C, Tsikitis VL. Anal intraepithelial neoplasia: diagnosis, screening, and treatment. Ann Gastroenterol 2019; 32(3): 257\u2013263. https:\/\/doi.org\/10.20524\/aog.2019.0364","journal-title":"Ann Gastroenterol"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaf052"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiaa801"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae124"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(19)30434-5"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001433"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmm.2015.08.019"}],"container-title":["International Journal of STD &amp; AIDS"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09564624261487508","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09564624261487508","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09564624261487508","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:18:49Z","timestamp":1789388329000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09564624261487508"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":10,"alternative-id":["10.1177\/09564624261487508"],"URL":"https:\/\/doi.org\/10.1177\/09564624261487508","relation":{},"ISSN":["0956-4624","1758-1052"],"issn-type":[{"value":"0956-4624","type":"print"},{"value":"1758-1052","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]},"article-number":"09564624261487508"}}