Acceptability of Anal Cancer Screening Tests for Women Living with HIV in the EVVA Study

Kaufman, Elaina; Castro, Christina De; Williamson, Tyler; Lessard, Bernard; Muňoz, Marie; Mayrand, Marie‐Hélène; Burchell, Ann; Klein, Martin; Charest, Louise; Auger, Manon; Marcus, Victoria; Coutlée, François; Pokomandy, Alexandra de

doi:10.3747/co.27.5401

Cited by 13 publications

(12 citation statements)

References 45 publications

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“…The high proportion of abnormalities on both anal cytology and HRA could also indicate underscreening in our clinic population. Qualitative studies have shown that anal cytology and HRA are feasible and acceptable to most PWH [ 23 , 24 ]. However, barriers to screening still exist, such as stigma, lack of awareness about HPV, and psychological discomfort associated with anal cancer screening [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Predictors of High-Grade Anal Dysplasia in People With HIV in One Southeastern Ryan White HIV/AIDS Program Clinic

Geba

Cardenas

Williams

et al. 2022

Open Forum Infectious Diseases

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Background Prevalence of anal cancer is increasing among people with HIV (PWH). Screening for anal cancer involves evaluating cytology and biopsy with high resolution anoscopy (HRA) if indicated. In this study, we sought to identify prevalence of abnormal anal cytology and biopsy-proven high-grade dysplasia, defined as anal intraepithelial neoplasia 2 and 3 (AIN2+). Methods Demographic and clinical data were collected from participants ≥30 years old with ≥1 anal Pap smear performed during the study period (12/18/2017-05/29/2021). A subgroup analysis was performed on those with ≥1 HRA. Logistic regression estimated adjusted odds ratios (aOR) for variables of interest such as age, race, gender, presence of HPV strains, and sexual practices. Results Of 317 participants, 48% (n = 152) had abnormal cytology (93% low-grade squamous intraepithelial lesion (SIL) or atypical cells of undetermined significance (ASCUS) and 7% high-grade SIL). Most with abnormal cytology proceeded to HRA (n = 136/152). Of those with HRA, 62% (n = 84/136) had AIN2 + . History of anoreceptive intercourse (aOR 4.62, 95% confidence interval (CI) 1.08-23.09, p = 0.047), HPV 16 (aOR 4.13, 95% CI 1.63-11.30, p = 0.004) and “other” high-risk HPV strains (aOR 5.66, 95% CI 2.31-14.78, p < 0.001) were significantly associated with AIN2 + . Conclusions Nearly half of those screened had abnormal cytology, highlighting the high prevalence of anal dysplasia in PWH. Though only 7% had high-grade SIL on cytology, 62% of those biopsied had AIN2 + suggesting cytology underestimates the severity of dysplasia on biopsy. HPV 16 and “other” high-risk strains were associated with AIN2 + and could be considered for risk-stratifying patients in the screening algorithm.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Predictors of High-Grade Anal Dysplasia in People With HIV in One Southeastern Ryan White HIV/AIDS Program Clinic

Geba

Cardenas

Williams

et al. 2022

Open Forum Infectious Diseases

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“…The EVVA study (“Evaluation of HIV, HPV, and AIN in Women”) is a prospective observational cohort study, which followed 151 WLHIV attending study visits every 6 months for 2 years [ 17 , 18 ]. Between January 2012 and July 2015, participants were recruited during routine HIV care at four HIV clinics in Montreal, Canada (McGill University Health Centre (MUHC), Clinique Médicale l’Actuel, Centre Hospitalier de l’Université de Montréal, and Clinique OPUS).…”

Section: Methodsmentioning

confidence: 99%

Identifying risk factors for prevalent anal human papillomavirus type 16 infection in women living with HIV

et al. 2022

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Background Women living with HIV (WLHIV) have a high risk of anal cancer. Identifying risk factors for anal HPV 16 infection, the most significant risk factor for anal cancer, is essential for prevention and screening strategies. Methods In the EVVA Cohort study, 151 WLHIV had cervical and anal HPV testing with genotyping every 6 months for 2 years, while demographic and clinical data were collected via questionnaires and chart reviews. Here, we present results of baseline data analyzed using multivariable logistic regression. Results Among 150 women with adequate HPV test results at baseline, HPV 16 DNA was detected anally in 23 (15.3%; 95%CI:10.4–22.1) and cervically in 5 (3.3%; 95%CI:1.4–7.8). In multivariable analysis, current smoking (OR = 6.0; 95%CI: 1.5–23.9), nadir CD4 count ≤ 200 cells/μL (OR = 8.4; 95%CI: 2.0–34.3), prevalent cervical HPV 16 (OR = 14.7; 95%CI: 1.0–222.5) and anogenital herpes in previous 6 months (OR = 9.8, 95%CI: 1.7–56.8) were associated with prevalent anal HPV 16. Conclusions Knowledge of risk factors can help identify WLHIV at greatest risk of anal HPV 16 infection and, potentially, developing subsequent anal cancer. Identification of the subgroup of these women in whom HPV 16 persists could be an early step in the algorithm of anal cancer screening.

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“…In one study, 87% of participants rated digital anal rectal examination as ".10 (very acceptable; so easy I would do it even more often)." 97 (See Appendix 7, http://links. lww.com/AOG/D275, for complete evidence summary.…”

Section: Techniques For Evaluationmentioning

confidence: 99%

Executive Summary of the Lower Anogenital Tract Cancer Evidence Review Conference

Chelmow

Cejtin

Conageski

et al. 2023

Obstetrics &Amp; Gynecology

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The Centers for Disease Control and Prevention sponsored a project conducted by the American College of Obstetricians and Gynecologists to develop educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. For this final module, focusing on the cancers of the lower anogenital tract (vulva, vagina, and anus), a panel of experts in evidence assessment from the Society for Academic Specialists in General Obstetrics and Gynecology, ASCCP, and the Society of Gynecologic Oncology reviewed relevant literature and current guidelines. Panel members conducted structured literature reviews, which were then reviewed by other panel members. Representatives from stakeholder professional and patient advocacy organizations met virtually in September 2022 to review and provide comment. This article is the executive summary of the review. It covers prevention, early diagnosis, and special considerations of lower anogenital tract cancer. Knowledge gaps are summarized to provide guidance for future research.

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Acceptability of Anal Cancer Screening Tests for Women Living with HIV in the EVVA Study

Cited by 13 publications

References 45 publications

Prevalence and Predictors of High-Grade Anal Dysplasia in People With HIV in One Southeastern Ryan White HIV/AIDS Program Clinic

Prevalence and Predictors of High-Grade Anal Dysplasia in People With HIV in One Southeastern Ryan White HIV/AIDS Program Clinic

Identifying risk factors for prevalent anal human papillomavirus type 16 infection in women living with HIV

Executive Summary of the Lower Anogenital Tract Cancer Evidence Review Conference

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