title: High Prevalence of Anal Human Papillomavirus-Associated Cancer Precursors in a Contemporary Cohort of Asymptomatic HIV-Infected Women.
abstract: BACKGROUND
  Although human immunodeficiency virus (HIV)-infected women are at high risk for anal cancer, few data have been published on prevalence of and risk factors for anal precancer and potential screening strategies in this risk group.
  
  
  METHODS
  A cross-sectional anal screening study was nested in a gynecological cohort of HIV-infected women. Anal swab specimens were collected for cytology and human papillomavirus (HPV) testing. High-resolution anoscopy, with biopsy when indicated, was systematically performed.
  
  
  RESULTS
  Among the 171 enrolled women, median age was 47.3 years and 98% were receiving combination antiretroviral therapy. Median CD4(+) count was 655 cells/µL and HIV load was <50 copies/mL in 89% of subjects. High-grade anal intraepithelial neoplasia or worse (HG-AIN+) was diagnosed in 12.9% (n = 21). In multivariable analysis, a history of cervical squamous intraepithelial lesion (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.1-16.4) and anal HPV-16 infection (OR, 16.1; 95% CI, 5.4-48.3) was associated with increased risk of HG-AIN+. Abnormal anal cytology and HPV-16 infection performed best as a screening strategy for HG-AIN+ histology, with positive likelihood ratios of 3.4 (95% CI, 2.3-5.1) and 4.7 (95% CI, 2.5-8.7) and negative likelihood ratios of 0.2 (95% CI, .07-.8) and 0.4 (95% CI, .2-.9), respectively.
  
  
  CONCLUSIONS
  HIV-infected women with a history of HPV-associated cervical disease are at increased risk for HG-AIN+ and should be offered anal cancer screening. Anal cytology and HPV-16 genotyping had the best screening performance. Anal cytology is easy to perform routinely; it may be the best candidate for screening for HG-AIN among HIV-infected women.
authors: French Human Papillomavirus Reference Laboratory, Institut Pasteur Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique, Hôpitaux de Paris (AP-HP).
authors: Isabelle
authors: I
authors: Heard
authors: Department of Proctology, Diaconesses-Croix Saint-Simon Group Hospitals.
authors: Isabelle
authors: I
authors: Etienney
authors: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136 INSERM, UMR_S 1136 INSERM Transfert, Paris.
authors: Valérie
authors: V
authors: Potard
authors: Aix Marseille Univ, Assistance Publique, Hôpitaux de Marseille, Sainte-Marguerite, Service d'Immuno-hématologie clinique, INSERM U912 (SESSTIM), Marseille, France.
authors: Isabelle
authors: I
authors: Poizot-Martin
authors: Scottish Human Papillomavirus Reference Laboratory, Edinburgh, United Kingdom.
authors: Catherine
authors: C
authors: Moore
authors: Department of Proctology, Diaconesses-Croix Saint-Simon Group Hospitals.
authors: Anne-Carole
authors: AC
authors: Lesage
authors: Aix Marseille Univ, Assistance Publique, Hôpitaux de Marseille, Sainte-Marguerite, Service d'Immuno-hématologie clinique, INSERM U912 (SESSTIM), Marseille, France.
authors: Emmanuelle
authors: E
authors: Ressiot
authors: AP-HP-Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Mourier, Colombes.
authors: Catherine
authors: C
authors: Crenn-Hebert
authors: Department of Pathology, AP-HP-Hôpitaux Universitaires de l'Est Parisien, Hôpital Saint-Antoine, Paris, France.
authors: Jean-François
authors: JF
authors: Fléjou
authors: Scottish Human Papillomavirus Reference Laboratory, Edinburgh, United Kingdom.
authors: Heather
authors: H
authors: Cubie
authors: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136 INSERM, UMR_S 1136.
authors: Dominique
authors: D
authors: Costagliola
authors: Department of Pathology, University of San Francisco, California.
authors: Teresa M
authors: TM
authors: Darragh
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000453:epidemiology*; D058070:Asymptomatic Diseases; D001706:Biopsy; D015331:Cohort Studies; D003218:Condylomata Acuminata / Q000150:complications / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003584:Cytological Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006651:Histocytochemistry; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology*; D011230:Precancerous Conditions / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment
keywords: HIV; anal cancer screening; anal intraepithelial neoplasia; human papillomavirus; women