Neukam, KarinMilanés Guisado, YusnelkisFontillón, MaríaMerino, LauraSotomayor, CésarEspinosa, NuriaLópez-Cortés, Luis FViciana, PompeyoSeVIHanal Study Group2024-10-232024-10-232019-02-01http://hdl.handle.net/10668/13507https://hdl.handle.net/20.500.12105/25243Objective: To determine the required learning time for high-resolution anoscopy (HRA)-guided biopsy to detect histological high-risk squamous intraepithelial lesions (hHSIL) and to identify factors that impact on the training process. Methods: All HIV-infected, screening-naïve men-who-have-sex-with-men who underwent HRA conducted by one single observer from 2010 to 2017 in a Spanish HIV-outpatient clinic were analysed. Results: Eighty-five (14.7%) of the 581 patients included presented hHSIL. The factors associated with the capacity to detect hHSIL [adjusted odds ratio (aOR), 95% confidence interval (95%CI)] were the presence of cytological HSIL (3.04, 1.78-5.21; p < 0.001), infection with high-risk human papilloma virus (HR-HPV) (2.89, 1.38-6.05; p = 0.005), the number of biopsies taken/HRA (aOR: 1.28, 1.07-1.52; p = 0.006) and tobacco smoking (1.75; 1.12-2.73; p = 0.014). Two events independently augmented the detection rate of hHSIL: one single experienced pathologist interpreted biopsies after 409 HRA (2.80, 1.74-4.48; p = 0.035) and the anoscopist underwent an additional training after 536 HRA (2.57, 1.07-6.16; p = 0.035). A learning process could be observed throughout the whole study with stable HR-HPV prevalence. Conclusion: The data support the growing evidence that the proposed training volume of 50-200 performances is underestimated. Extensive training of both anoscopist and pathologist is warranted and the development of tools to support the diagnostic performance may be considered.engVoRhttp://creativecommons.org/licenses/by-nc-nd/4.0/Anal squamous cell carcinomaHigh-resolution anoscopyHuman papillomavirusLearning curveLiquid-based cytologyOperator experienceAdultAnus NeoplasmsBiopsyEndoscopyHIV InfectionsHumansLearning CurveMaleMiddle AgedPreceptorshipProspective StudiesRetrospective StudiesSpainSquamous Intraepithelial LesionsTime FactorsAttribution-NonCommercial-NoDerivatives 4.0 International30716543762-6610.1016/j.pvr.2019.01.0032405-8521Papillomavirus research (Amsterdam, Netherlands)open access