title: Anal human papillomavirus (HPV) prevalences and factors associated with abnormal anal cytology in HIV-infected women in an urban cohort from Rio de Janeiro, Brazil.
abstract: Identifying factors, including human papillomavirus (HPV) genotypes, associated with abnormal anal cytology in HIV-infected women have implications for anal squamous cell cancer (SCC) prevention in HIV-infected women. Anal and cervical samples were collected for cytology, and tested for high-(HR-HPV) and low-risk HPV (LR-HPV) genotypes in a cross-sectional analysis of the IPEC Women's HIV Cohort (Rio de Janeiro, Brazil). Multivariate log-binomial regression models estimated prevalence ratios for factors associated with abnormal anal cytology [≥ atypical squamous cells of undetermined significance, (ASC-US)]. Characteristics of the 863 participants included: median age 42 years, 57% non-white, 79% current CD4+ T-cell count >350 cells/mm(3), 53% HIV-1 viral load <50 copies/mL, median ART duration 5.8 years. Fifty-one percent of anal specimens contained ≥ 1 HR-HPV genotype; 31% had abnormal anal cytology [14% ASC-US, 11% low-grade squamous intra-epithelial lesion, (LSIL); 2% atypical squamous cells-cannot exclude high-grade SIL (ASC-H); 4% high-grade SIL/cancer (HSIL+)]. In multivariate analysis, cervical LSIL+, nadir CD4+ T-cell count ≤ 50 cells/mm(3), HIV-1 viral load ≥ 50 copies/mL, and anal HPV 6, 11, 16, 18, 33, 45, 52, 56, and 58 were associated with ≥ anal ASC-US (p<0.05). Abnormal anal cytology and HR-HPV prevalences were high. HIV-infected women with cervical LSIL+, low nadir CD4+ counts, or detectable HIV-1 viral loads should be a particular focus for enhanced anal SCC screening efforts.
authors.affiliation: 1 Division of Infectious Diseases and Program in Global Health, David Geffen School of Medicine at UCLA , Los Angeles, California.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Cambou
authors.forename: Paula M
authors.initials: PM
authors.lastname: Luz
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Lake
authors.forename: José Eduardo
authors.initials: JE
authors.lastname: Levi
authors.forename: José Ricardo
authors.initials: JR
authors.lastname: Coutinho
authors.forename: Angela
authors.initials: A
authors.lastname: de Andrade
authors.forename: Thais
authors.initials: T
authors.lastname: Heinke
authors.forename: Mônica
authors.initials: M
authors.lastname: Derrico
authors.forename: Valdilea G
authors.initials: VG
authors.lastname: Veloso
authors.forename: Ruth K
authors.initials: RK
authors.lastname: Friedman
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology / Q000821:virology*; D001004:Anus Diseases / Q000453:epidemiology* / Q000821:virology; D001938:Brazil / Q000453:epidemiology; D015496:CD4-Positive T-Lymphocytes; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000235:genetics / Q000821:virology; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D027383:Papillomaviridae / Q000235:genetics* / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D014505:Urban Population
chemical_list: D004279:DNA, Viral