Primary Anal Cancer Screening Results From 381 Women With Human Immunodeficiency Virus

Abstract

Background Women living with human immunodeficiency virus (WLH) have an elevated risk for human papillomavirus (HPV)-associated anal cancer. Primary anal cancer screening results from this population could inform practice guidelines. Methods 381 WLH with anal cytology screening, high-risk HPV (hrHPV) testing and genital (cervical or vaginal) cotesting within 6 months were identified during 2012-2019. Those with anal cytology of Atypical Squamous Cells of Undetermined Significance or worse (ASCUS+) underwent high-resolution anoscopy and biopsy. Independent predictors of anal hrHPV, HPV16 and histological anal high-grade squamous intraepithelial lesions (aHSIL) were identified using adjusted logistic regression models. Results Prevalence of anal hrHPV, HPV16 and ASCUS + cytology was 61%, 13% and 68%. Histological aHSIL was detected in 42% of WLH with anal cytology of ASCUS + . Prevalence of genital hrHPV, HPV16 and ASCUS + cytology was 30%, 4% and 28%. Genital hrHPV predicted anal hrHPV (odds ratio [OR] 5.05), while genital HPV16 predicted anal HPV16 (OR 9.52). Genital hrHPV and anal HPV16 predicted histological aHSIL (ORs 2.78 and 10.9). Conclusions Anal HPV disease was highly prevalent in this primary screening cohort of WLH. While genital screening results predicted anal disease, rates of isolated anal HPV disease were substantial, supporting universal anal cancer screening for this population.

Anogenital HPV-Related Cancers in Women: Investigating Trends and Sociodemographic Risk Factors

“…There is clearly a large amount of overlap between different hrHPV-driven anogenital pathologies, which could be arguably considered one entity, given that at least 30% of women with cervical and/or vulval HSIL have been shown to have anal HSIL [ 4 , 20 , 21 , 22 ], a percentage which has been shown to increase to 57% in women with more than one focus of HSIL [ 21 ]. With a 10- to 20-year lag between cervical and anal disease, as well as limited research, lack of anal disease surveillance and the fact that cervical screening has only recently changed in 2016 from cytology to hrHPV testing, it is possible that women affected by vulval, and anal disease were colonised with hrHPV in the cervix earlier in life.…”