The team determined the prevalence of human papillomavirus (HPV)-related abnormalities of the anal canal in women. They also characterized the risk-factors for these lesions, and reported their findings in the Journal of the National Cancer Institute.
Anal cancers are thought to arise from squamous intraepithelial lesions in the anal canal, and women infected with human immunodeficiency virus-1 (HIV) may be at higher risk of anal cancer.
The team evaluated HPV-related abnormalities in 251 HIV-positive and in 68 HIV-negative women.
|Proportion of women with abnormal anal cytology:|
|Journal of the National Cancer Institute|
Physical examinations were conducted and questionnaire data on medical history and relevant sexual practices was obtained.
Univariate and adjusted relative risks (RRs) were calculated.
Abnormal anal cytology was diagnosed in 26% of HIV-positive and in 8% of HIV-negative women. Such cytology included atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesions, or high-grade squamous intraepithelial lesions (HSILs).
HSILs were detected by histology or cytology in 6% of HIV-positive and in 2% of HIV-negative women.
The researchers found that HIV-positive women showed increased risk of anal disease as the CD4 count decreased, and as the plasma HIV RNA viral load increased.
HIV-positive women with abnormal cervical cytology were twice as likely to have abnormal anal cytology at the same visit.
In addition, abnormal anal cytology in HIV-positive women was associated with the detection of anal HPV RNA (RR = 4.3).
In a multivariate analysis, the history of anal intercourse and concurrent abnormal cervical cytology were also significantly associated with abnormal anal cytology.
Author Elizabeth A. Holly, of the Department of Epidemiology and Biostatistics, concluded on behalf of colleagues, "HIV-positive women had a higher risk of abnormal anal cytology than did HIV-negative women with high-risk lifestyle factors.
"These data provide strong support for anoscopic and histologic assessment, and careful follow-up of women with abnormal anal lesions."