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HIV-infected women with HPV at increased risk for high-grade anal intraepithelial neoplasia
Women with HIV and a history of HPV-related cervical disease are at heightened risk for developing high-grade anal intraepithelial neoplasia, and screening for anal cancer may be warranted in this population, according to recent findings.
“In HIV-infected women, the risk for anal cancer is approximately 14 times higher than among HIV-negative women diagnosed with AIDS, with the anal cancer rate estimated at 30-36 per 100,000 person-years,” researchers wrote in Clinical Infectious Diseases. “Despite the introduction of highly active combined antiretroviral therapy (cART), there is no evidence of a declining incidence of anal cancer.”
In a nested cross-sectional substudy, the researchers evaluated 171 participants in the VIHGY cohort, a longitudinal, multicenter study of HIV-infected women in France. The median patient age was 47.3 years. Eligible participants in the substudy had no history of anal cancer and were recruited during their first VIHGY visit in 2012. Anal HPV specimens were collected during a gynecological examination, and when biopsy was indicated, high-resolution anoscopy was performed at specialized anal dysplasia clinics.
According to the researchers, 98% of the participants were on a cART regimen. The median CD4+ cell count was 655/cells mm3, and 89% of the participants had HIV loads of less than 50 copies/mL. The researchers diagnosed high-grade anal intraepithelial neoplasia (HG-AIN) or worse in 12.9% of participants. Multivariable analysis revealed associations between increased HG-AIN risk and a history of cervical squamous intraepithelial lesion (OR = 4.2; 95% CI, 1.1-16.4) and anal HPV16 infection (OR = 16.1; 95% CI, 5.4-48.3). The most effective screening approaches for HG-AIN histology were abnormal anal cytology, which had a positive likelihood ratio of 3.4 (2.3-5.1), and HPV genotyping, which had a positive likelihood ratio of 4.7 (2.5-8.7).
According to the researchers, screening for anal cancer may be easily incorporated into the preventive care of this patient population.
“Although the effectiveness of treatment of anal [HG‐AIN] has not been fully established, anal cytology and HPV testing appear to be well accepted by both gynecologists and patients; these tests could readily be offered to HIV‐infected women during their gynecological examination and may facilitate the early detection and treatment of anal cancer and its precursors,” they wrote. – by Jen Byrne
Disclosure: Heard reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.