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Anal dysplasia, HPV incidence high among women with HIV

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BOSTON — Abnormal anal cytology and high-risk HPV had a high prevalence among women with HIV in Johannesburg, South Africa, researchers reported here at the 2014 Conference on Retroviruses and Opportunistic Infections.

“HPV-related cervical cancer is a common cause of morbidity and mortality in women with HIV in Sub-Saharan Africa,” Bridgette Goeieman, MD, of the University of Witwatersrand in Johannesburg, said during a press conference. “HPV also causes anal cancer, but the incidence of anal cancer in this population is unclear. There are very limited data on anogenital cancer, other than cervical cancer and dysplasia, among HIV-positive individuals in South Africa."

Goeieman and colleagues conducted a prospective cohort study that included 88 women aged 25 to 65 years who were receiving treatment at an HIV clinic in Johannesburg. The women provided anal swabs that underwent cytology and oncogenic HPV testing. Women who had abnormal cytology and 20% of women with normal cytology underwent high-resolution anoscopy with biopsy of visible lesions. The women also underwent cervical cytology.

Nine women had normal anal cytology, 61 women had low-grade squamous intraepithelial lesions and 16 had high-grade squamous intraepithelial lesions. Most women (84%) also had abnormal cervical cytology.

Anal biopsies were taken from 48 women. Among these women, 23 had a negative histology; nine had atypia; 11 had low-grade anal intraepithelial neoplasia; and five had high-grade anal intraepithelial neoplasia.

High-risk HPV was identified on the anal swabs of 45% of the women and on cervical swabs of 36% of the women. Among the women with low-grade squamous intraepithelial lesions on cytology, 34% had high-risk anal HPV. Among the women with high-grade squamous intraepithelial lesions on cytology, 75% had high-risk anal HPV.

“We found high-grade lesions on biopsy in 10% of the women who underwent anal biopsy, and this is likely an underestimate due to the high number of lesions discovered on cytology,” Goeieman said. “Further studies are required, as this population is underscreened for anal dysplasia. This information could assist in advocating for the use and availability of HPV vaccine in this population.”

For more information:

Goeieman B. #718. Presented at: 2014 CROI; March 3-6, 2014; Boston.

Disclosure: Goeieman reports no relevant financial disclosures.