Anal high-risk HPV common among transgender women
Key takeaways:
- Among a cohort of 80 transgender women, 24% had receive HPV immunization and 73% were positive for high-risk HPV.
- Rates of HPV and abnormal cytology were elevated regardless of HIV status.
Anal high-risk HPV and abnormal cytology were common among transgender women regardless of their age, HIV status and/or hormone use, researchers determined.
“Anal cancer is caused by anal HPV infection. The risk for anal cancer is increased in people living with HIV,” Omar Harfouch MD, MPH, assistant professor of medicine in the department of infectious diseases at the University of Maryland School of Medicine, told Healio. “Transgender populations notably transgender women are disproportionately affected by anal cancer, HPV and HIV. However, on what factors associated with anal HPV infection in this population.”
Harfouch and colleagues aimed to provide some of these data by recruiting adults identifying as transgender to an urban academic-community clinic where they provided blood samples, anal swabs for high-risk HPV and cytology, and completed surveys on sexual behaviors and gender-affirming hormones. The researchers then used logistic regression to identify predictors of high-risk HPV and abnormal cytology.
Of 97 transgender patients, 80 were assigned male at birth. Of them, 66% were HIV positive, 73% tested positive for anal high-risk HPV and 48% had abnormal cytology. Additionally, only 24% of these patients recalled receiving HPV immunization.
The researchers determined that transgender women with HIV had an increased risk of HPV16 infections (37% vs. 8%; P = .014). They added, however, that the prevalence of high-risk HPV and abnormal cytology were similarly elevated regardless of patient HIV status (80% vs. 62% and 56% vs. 32%, respectively).
59% of the cohort were taking affirming hormones with 14% taking estradiol only, 15% androgen blockage only and 30% taking both. The researchers determined that neither estradiol use either current or past or androgen blockade were associated with any high-risk HPV or abnormal cytology (P = .05). They noted, however, that higher testosterone levels were associated with any high-risk HPV (P = .014).
“Transgender women are at high risk for anal cancer, anal HPV and abnormal pap test,” Harfouch said, adding that efforts need to be made to improve primary prevention such as early vaccination and secondary prevention including anal pap test and referral to anoscopy when appropriate.
“More research is needed to better understand the longitudinal anal cancer risk in our population and what factors are associated with that increased risk,” Harfouch said.
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