title: Cervical and anal HPV infection: cytological and histological abnormalities in HIV-infected women in Thailand.
abstract: BACKGROUND
  Women infected with human immunodeficiency virus (HIV) have higher rates of persistent infection with high-risk human papillomavirus (hr-HPV) and cervical and anal dysplasia. We describe the epidemiology of hr-HPV, and cervical and anal intra-epithelial abnormalities in HIV-infected women in Thailand.
  
  
  METHODS
  HIV-infected women aged 18-49 years, either HAART-naïve or -experienced, were enrolled in Bangkok, Thailand. A demographic and sexual-risk behaviour questionnaire was administered and a pelvic examination with colposcopy was performed on every woman. Cervical and anal samples were tested for cytology and HPV genotyping.
  
  
  RESULTS
  A total of 256 women were enrolled with a median [interquartile range (IQR)] age of 35 (32-40) years. Ninety (35.2%) had detectable cervical hr-HPV. Being post-menopausal was associated with increased risk for cervical hr-HPV, while years since HIV diagnosis and plasma HIV RNA <40 copies/mL were significantly associated with decreased risk in multivariable regression analyses. Abnormal cervical cytology was detected in 6.3%. Cervical biopsies that were taken from 99 women (39.3%) owing to abnormalities seen during colposcopy showed cervical intra-epithelial neoplasia (CIN) in 22.6%. The sensitivity of cervical cytology to detect CIN2+ was 10.0%. Among 102 women enrolled in the anal substudy, 18.8% had anal HPV infection and 11.1% had anal hr-HPV. Two women had abnormal anal cytology.
  
  
  CONCLUSIONS
  We found cervical and anal hr-HPV in 35.2% and 11.1% of Thai HIV-infected women, respectively. Moreover, the observed poor agreement between cervical cytology and histology results could indicate current cervical cancer screening programs for HIV-infected women might not be optimal for the detection of pre-neoplastic lesions.
authors.affiliation: HIV Netherlands Australia Thailand Research Collaboration (HIVNAT), Bangkok, Thailand; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, the Netherlands.
authors.forename: Reshmie A
authors.initials: RA
authors.lastname: Ramautarsing
authors.affiliation: Thai Red Cross AIDS Research Centre (TRCARC) , Bangkok , Thailand.
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phanuphak
authors.affiliation: Department of Medicine, Faculty of Obstetrics and Gynecology , Chulalongkorn University , Bangkok , Thailand.
authors.forename: Surasith
authors.initials: S
authors.lastname: Chaithongwongwatthana
authors.affiliation: Department of Global Health, Academic Medical Center , University of Amsterdam, Amsterdam Institute for Global Health and Development (AIGHD) , Amsterdam , the Netherlands.
authors.forename: Ferdinand Wnm
authors.initials: FW
authors.lastname: Wit
authors.affiliation: Thai Red Cross AIDS Research Centre (TRCARC) , Bangkok , Thailand.
authors.forename: Nipat
authors.initials: N
authors.lastname: Teeratakulpisarn
authors.affiliation: Thai Red Cross AIDS Research Centre (TRCARC) , Bangkok , Thailand.
authors.forename: Tippawan
authors.initials: T
authors.lastname: Pankam
authors.affiliation: Thai Red Cross AIDS Research Centre (TRCARC) , Bangkok , Thailand.
authors.forename: Piyanee
authors.initials: P
authors.lastname: Rodbamrung
authors.affiliation: Henry M Jackson Foundation for the Advancement of Military Medicine , Maryland , USA.
authors.forename: Janneke H
authors.initials: JH
authors.lastname: Wijgert
authors.affiliation: HIV Netherlands Australia Thailand Research Collaboration (HIVNAT), Bangkok, Thailand; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, the Netherlands.
authors.forename: Joep Ma
authors.initials: JM
authors.lastname: Lange
authors.affiliation: HIV Netherlands Australia Thailand Research Collaboration (HIVNAT), Bangkok, Thailand; Thai Red Cross AIDS Research Centre (TRCARC), Bangkok, Thailand; Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Praphan
authors.initials: P
authors.lastname: Phanuphak
authors.affiliation: Vanderbilt Institute for Global Health , Nashville , TN , USA .
authors.forename: Vikrant V
authors.initials: VV
authors.lastname: Sahasrabuddhe
authors.affiliation: HIV Netherlands Australia Thailand Research Collaboration (HIVNAT), Bangkok, Thailand; The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kerr
authors.affiliation: HIV Netherlands Australia Thailand Research Collaboration (HIVNAT), Bangkok, Thailand; Thai Red Cross AIDS Research Centre (TRCARC), Bangkok, Thailand; Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; SEARCH, Bangkok, Thailand,; US Military HIV Research Program, Walter Reed Army Institute of Research.
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
keywords: HIV; Pap smear; Thailand; anal HPV; cervical HPV; women