Prevalence of Anal HPV and Anal Dysplasia in HIV-Infected Women From Johannesburg, South Africa

Abstract

BACKGROUND Anal cancer is a relatively common cancer among HIV-infected populations. There are limited data on the prevalence of anal high-risk human papillomavirus (HR-HPV) infection and anal dysplasia in HIV-infected women from resource-constrained settings. METHODS A cross-sectional study of HIV-infected women age 25–65 recruited from an HIV clinic in Johannesburg, South Africa. Cervical and anal swabs were taken for conventional cytology and HR-HPV testing. Women with abnormal anal cytology and 20% of women with negative cytology were seen for high resolution anoscopy (HRA) with biopsy of visible lesions. RESULTS Two hundred women were enrolled. Anal HR-HPV was found in 43%. The anal cytology results were negative in 51 (26%); 97 (49%) had low-grade squamous intraepithelial lesions (SIL), 32 (16%) had atypical squamous cells of unknown significance and 19 (9.5%) had high-grade SIL or atypical squamous cells suggestive of high-grade SIL. On HRA, 71 (36%) had atypia or low-grade SIL on anal histology and 17 (8.5%) had high-grade SIL. Overall 31 (17.5%) had high-grade SIL present on anal cytology or histology. Abnormal cervical cytology was found in 70% and cervical HR-HPV in 41%. CONCLUSION We found a significant burden of anal HR-HPV infection, abnormal anal cytology and high-grade SIL in our cohort. This is the first study of the prevalence of anal dysplasia in HIV-infected women from sub-Saharan Africa. Additional studies are needed to define the epidemiology of these conditions, as well as the incidence of anal cancer, in this population.

Acceptability of high‐resolution anoscopy for anal cancer screening in HIV‐infected patients

“…For HRA to be successful as a cancer prevention strategy, it needs to be both effective and tolerable to the target patient population. While previous studies have examined the clinical utility and performance of HRA , few have documented patient experience with HRA, including the tolerability of discomfort during the procedure and postprocedure pain, as well as patient willingness to undergo routine or follow‐up HRA .…”

Anal HPV infection and correlates in HIV-infected patients attending a Sexually Transmitted Infection clinic in Brazil

“…Regarding clinical variables, HIV viral load and low CD4 counts were significantly associated with HR-HPV and multiple infections, which could raise the risk of persistent infection and consequently, of malignant development. Our result showed that HAART therapy was protective for multiple HPV infection, and it was previously demonstrated that HR-HPV prevalence was lower in patients in the long-term application of HAART [ 39 , 40 ]. However, the incidence of HPV-induced lesions in the anal canal are still high in patients on a program of HAART [ 41 ], and the frequency of anal cancer was no different in the pre-HAART and HAART eras [ 42 ].…”

Prevalence of and Risk Factors for Anal High-grade Squamous Intraepithelial Lesions in Women Living with Human Immunodeficiency Virus

“…The 2016 International Guidelines for Practice Standards in the Detection of Anal Cancer Precursors proposes a quality assurance metric: >90% of patients with cytologic HSIL should have hHSIL detected on HRA [23]. In other studies, the proportion of study participants having hHSIL detected in association with cytology anal HSIL was 67% (73/109) in Machalek et al [24], 52% (11/21) (with ASC-H included as HSIL cytology) in Heard et al [13], and 35% (6/17) (with ASC-H included as HSIL cytology) in Goeieman et al [14]. In addition, we found that random biopsies of the anal canal in our cohort of HIV-infected women did not add significantly to the detection of anal hHSIL (2/69 [3%]).…”

“…Heard et al [13] performed HRA on all patients and detected histologic HSIL in 6.4% (11/171) of their cohort. Studies of HIV-infected women in which only women with abnormal anal cytology underwent HRA found rates of anal hHSIL ranging from 4% to 9% [14][15][16][17][18][19]. The largest reported cohort by Gaisa et al found that of 795 HIV-infected women undergoing anal cancer screening with anal cytology, 39% of anal cytology specimens were abnormal; however, only 50% of the women with abnormal anal cytology underwent HRA [16].…”

“…Kojic et al, in a cohort study of 120 HIV-infected women in the United States, found that 38% had abnormal anal cytology compared with the 33% with abnormal cervical cytology [22]. In their cohort of HIV-infected women from Johannesburg, South Africa, Goeieman et al reported that 74% had abnormal anal cytology compared with 70% with abnormal cervical cytology [14].…”