Anal high-grade intraepithelial neoplasia and cancer in women with HIV and women without HIV with other risk factors

Objective: To determine the prevalence and the risk factors for anal high-grade intraepithelial neoplasia and anal cancer (HSILþ) in women with HIV (WWH), and to compare them to women without HIV with other risk factors. Design: Prospective cohort study. Methods: WWH and women without HIV with other risk factors were included. Screening for anal HSILþ using anal cytology and HPV testing was performed. A high-resolution anoscopy with directed biopsy was also performed in patients with an abnormal cytology result or a positive HPV testing for high-risk (HR) genotypes, and in those with anal symptoms. Results: The period prevalence of anal HR-HPV infection and histological HSIL was 57.9% and 10.9% among WWH, and 60.8% and 9.2% among women without HIV. The prevalence of anal HPV 18 infection was higher in WWH. The risk factors for anal HSILþ in WWH included anal HPV 16, other HR genotypes and low-risk genotypes infection, as well as a history of vulvar HSILþ. In women without HIV, the risk factors included anal HPV 16 infection, history of anogenital warts and of vulvar HSILþ, and immunosuppressive treatment. Conclusions: A high prevalence of anal HPV infection and HSIL was observed in WWH and women without HIV with other risk factors. Both groups share anal HPV 16 infection and history of vulvar HSILþ as risk factors for the development of anal HSILþ. Genotyping for anal HPV 16 may help identify women at higher risk of anal cancer.