title: Prevalence of Anal HPV and Anal Dysplasia in HIV-Infected Women From Johannesburg, South Africa.
abstract: Anal cancer is a relatively common cancer among HIV-infected populations. There are limited data on the prevalence of anal high-risk human papillomavirus (HR-HPV) infection and anal dysplasia in HIV-infected women from resource-constrained settings.
  
  
  
  A cross-sectional study of HIV-infected women aged 25-65 years recruited from an HIV clinic in Johannesburg, South Africa. Cervical and anal swabs were taken for conventional cytology and HR-HPV testing. Women with abnormal anal cytology and 20% of women with negative cytology were seen for high-resolution anoscopy with biopsy of visible lesions.
  
  
  
  Two hundred women were enrolled. Anal HR-HPV was found in 43%. The anal cytology results were negative in 51 (26%); 97 (49%) had low-grade squamous intraepithelial lesions (SIL), 32 (16%) had atypical squamous cells of unknown significance, and 19 (9.5%) had high-grade SIL or atypical squamous cells suggestive of high-grade SIL. On high-resolution anoscopy, 71 (36%) had atypia or low-grade SIL on anal histology and 17 (8.5%) had high-grade SIL. Overall, 31 (17.5%) had high-grade SIL present on anal cytology or histology. Abnormal cervical cytology was found in 70% and cervical HR-HPV in 41%.
  
  
  
  We found a significant burden of anal HR-HPV infection, abnormal anal cytology, and high-grade SIL in our cohort. This is the first study of the prevalence of anal dysplasia in HIV-infected women from sub-Saharan Africa. Additional studies are needed to define the epidemiology of these conditions, as well as the incidence of anal cancer, in this population.
authors.affiliation: *Right to Care, Johannesburg, South Africa; †Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‡Julius Clinical Research, Zeist, the Netherlands; §Cytology Unit, Department of Anatomical Pathology, Faculty of Health Sciences, National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa; ‖Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; ¶National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa; #Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; and **Division of Infectious Diseases, Weill Cornell Medicine, New York, NY.
authors.forename: Bridgette J
authors.initials: BJ
authors.lastname: Goeieman
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Firnhaber
authors.forename: Eefje
authors.initials: E
authors.lastname: Jong
authors.forename: Pam
authors.initials: P
authors.lastname: Michelow
authors.forename: Patricia
authors.initials: P
authors.lastname: Kegorilwe
authors.forename: Avril
authors.initials: A
authors.lastname: Swarts
authors.forename: Anna-Lise
authors.initials: AL
authors.lastname: Williamson
authors.forename: Bruce
authors.initials: B
authors.lastname: Allan
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wilkin
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology* / Q000821:virology; D001004:Anus Diseases / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D003430:Cross-Sectional Studies; D003581:Cytodiagnosis; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D015995:Prevalence; D011351:Proctoscopy; D013019:South Africa / Q000453:epidemiology