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Human Papilloma Virus (HPV) Infection of the Anus Is More Prevalent and Diverse than Cervical HPV Infection among HIV-Infected Women in the SUN Study
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IDSA, Oct 2006
SUSAN CU-UVIN, MD1, E. MILU KOJIC, M.D.1, LOIS CONLEY, M.P.H.2, TIM BUSH, M.D.2, ELIZABETH UNGER, M.D. P.h.D.2, KEITH HENRY, M.D.3, JOHN HAMMER, M.D.4, TURNER OVERTON, M.D.5, JOEL PALEFSKY, M.D.6, JOHN T. BROOKS, M.D.2;
1The Miriam Hospital, Providence, RI,2Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA,3Hennepin County Medical Center, Minneapolis, MN,4Denver Infectious Disease Consultants, Denver, CO,5Washington University School of Medicine, St Louis, MO,6University of California, San Francisco, CA.
Financial Disclosures:
Abstract:
Genital HPV infection is highly prevalent and persistent in women with HIV infection; however, the ecology of anal HPV infection in women has not been well described.
The SUN is a prospective study of HIV-infected patients. At baseline, all patients completed a behavioral risk questionnaire and providers collected, among other, cervical ThinPrep cytobroom and Dacron anal swabs for HPV detection and genotyping using Roche Linear Assay.
Results:
Among the first 99 women enrolled, median age was 40 years, 84% were on HAART, and 92% had CD4 cells >200 cells/mm3.
HPV was detected significantly more often in anal (92%) than in cervical (85%) samples (p=0.03) but did not differ significantly among women reporting a history of anal sex, 41%, compared with women who did not (86% vs. 95% of anal samples, p=0.17; and 78% vs. 87% of cervical samples, p=0.24).
High risk (HR) types were detected in 80% of anal and 66% of cervical samples (p<0.01) and low risk (LR) in 76% of anal and 60% of cervical samples (p<0.01).
HPV 16 and 18 were detected in 27% of anal and 15% of cervical samples (p=0.02). The mean number of HPV types was greater in anal vs. cervical samples for all types of HPV (4.1 vs. 2.1, p≦0.01), for HR types (2.3 vs. 1.1, p≦0.01), and for LR types (1.7 vs. 1.1, p<0.01).
Conclusion:
In HIV-infected women, prevalence and diversity of HPV are greater in the anal canal than cervix. Studies in HIV-infected persons examining the clinical consequences of long-term anal HPV infection and anal cancer screening methods should include women.
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