title: High Rates of Anal High-Grade Squamous Intraepithelial Lesions in HIV-Infected Women Who Do Not Meet Screening Guidelines.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-infected women have a higher burden of anal high-grade squamous intraepithelial lesions (HSIL) and anal cancer (AC) compared with HIV-uninfected women. Guidelines for AC screening in this population are heterogeneous. Here we report outcomes and risk factors for anal HSIL following implementation of universal AC screening offered to all HIV-infected women.
  
  
  METHODS
  Data from women who underwent AC screening with anal cytology from April 2009 to July 2014 were analyzed. Routine clinical data included anal and cervical cytology, demographic/behavioral data, and high-resolution anoscopy (HRA) results. We evaluated the association of cytology with HRA results, and predictors of HSIL pathology, and compared rates of HSIL pathology among women meeting screening guidelines to those who did not.
  
  
  RESULTS
  Seven hundred forty-five HIV-infected women were screened with anal cytology. Thirty-nine percent had abnormal anal cytology on initial screen and 15% on secondary screen; 208 women underwent HRA following abnormal anal cytology. HSIL was found in 26% and 18% of anal biopsies following initial and secondary screening, respectively. One woman had AC. Cigarette smoking more than doubled HSIL risk. Among women who underwent AC screening despite not meeting existing guideline criteria, 21% and 10%, respectively, were found to have HSIL on biopsy. Neither meeting criteria for screening nor history of receptive anal sex was significantly associated with HSIL.
  
  
  CONCLUSIONS
  Anal HSIL is common in HIV-infected women. Substantial numbers of HSIL would have been missed by strictly adhering to existing AC screening guidelines. These results support routine screening of all HIV-infected women regardless of human papillomavirus history or sexual practices.
authors.affiliation: Divisions of Infectious Diseases and michael.gaisa@mssm.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Gaisa
authors.affiliation: Divisions of Infectious Diseases and.
authors.forename: Fanny
authors.initials: F
authors.lastname: Ita-Nagy
authors.affiliation: Divisions of Infectious Diseases and.|General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York.
authors.forename: Keith
authors.initials: K
authors.lastname: Sigel
authors.affiliation: General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York.
authors.forename: Yotam
authors.initials: Y
authors.lastname: Arens
authors.affiliation: Adult Comprehensive Services, Jacobi Medical Center, Bronx, New York.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Hennessy
authors.affiliation: Divisions of Infectious Diseases and.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rodriguez-Caprio
authors.affiliation: Divisions of Infectious Diseases and.
authors.forename: Michael
authors.initials: M
authors.lastname: Mullen
authors.affiliation: Divisions of Infectious Diseases and.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Aberg
authors.affiliation: Divisions of Infectious Diseases and.
authors.forename: Michelle
authors.initials: M
authors.lastname: Cespedes
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology*; D001005:Anus Neoplasms / Q000453:epidemiology* / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000821:virology; D003218:Condylomata Acuminata / Q000453:epidemiology / Q000473:pathology; D055088:Early Detection of Cancer; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D061705:Image-Guided Biopsy; D008137:Longitudinal Studies; D008875:Middle Aged; D009519:New York City; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
keywords: HIV; HPV; HSIL; anal cancer; women.