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One Third of HIV+ Women in Spanish Group Have Anal Cancer Precursor
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ICAAC 2014. September 5-9, 2014. Washington, DC
Mark Mascolini
One third of HIV-positive women in a prospective Spanish cohort had anal squamous intraepithelial lesions (ASIL), an anal cancer precursor [1]. Half of men who have sex with men (MSM) in the same cohort had ASIL.
ASIL and anal cancer are the focus of intense study in MSM with and without HIV infection. But human papillomavirus (HPV)-induced anal lesions and cancer are not rare among women with HIV. A US study of HPV-related cancer incidence in people with AIDS from 1980 to 2004 determined that women with AIDS had a 14.5-fold higher anal cancer incidence than women in the general population [2].
Researchers working with an HIV cohort in southern Spain analyzed ASIL rates and risk factors in women and MSM in their cohort. All study participants gave anal mucosal samples for cytology. People with ASIL or anal high-risk (cancer-causing) HPV had high-resolution anoscopy.
The study involved 260 people, 77 of them (30%) women and 183 (70%) MSM. Women averaged 43.4 years in age and men 37.3. Among women and men, 29% and 100% reported anal intercourse, 26% and 33.3% had a history of genital or anal warts, and 10.4% and 29.5% currently had genital warts. Two thirds of women and 46% of men smoked.
Women had HIV infected for a median 165 months, compared with 31 months in men. Median CD4 was high in both women and men (659 and 680). Only 6.5% of women but 21% of men had not started antiretroviral therapy. Viral load averaged 4.2 log in women and 5.4 log in men (about 16,000 and 250,000 copies).
Among women and men, 50% and 75% tested positive for high-risk HPV in anal samples, while 30% and 48% had both high-risk and low-risk anal HPV. HPV-16, the genotype most often linked to anal or cervical cancer, was the most prevalent genotype in both women (15.6%) and men (31.1%).
Anal cytology indicated ASIL in 31% of women and 51% of men, high-grade squamous intraepithelial neoplasia (HSIL) in 1% of women and 4% of men, atypical squamous cells of unknown significance in 1% of women and 6% of men, and normal results in 67% and 39%.
Among 183 MSM and 27 women who had anoscopy, the procedure detected LSIL (anal intraepithelial neoplasia [AIN]1) in 55.6% of women and 47.5% of men, HSIL (AIN2 or 3) in 18.5% of women and 19.1% of men, ASCUS in no women or men, and normal results in 25.9% of women and 33.3% of men.
If anal cytology in women was normal, anoscopy showed normal results in 27%, LSIL (AIN1) in 54.5%, and HSIL (AIN2/3) in 18%. If anal cytology indicated LSIL in women, anoscopy showed normal results in 23.5%, LSIL in 59%, and HSIL in 17.5%. Among women who tested positive for high-risk HPV, 20% were normal by anoscopy, 55% had LSIL, and 25% had HSIL. Among women with normal cytology but high-risk HPV, anoscopy indicated normal histology in 30%, LSIL in 50%, and HSIL in 20%.
Logistic regression analysis linked two factors to higher odds of ASIL in women. Anal or genital warts raised the odds 584 times (adjusted odds ratio 584, 95% confidence interval 2.5 to 133,155), and HPV-16 upped the odds 68 times (adjusted odds ratio 68, 95% confidence interval 1.2 to 3720).
The researchers concluded that anoscopy-detected HSIL remains relatively rare among women in their cohort, affecting 5 of 77 (6.5%). In contrast, 35 of 183 men (19.1%) had HSIL by anoscopy. But one third of women and half of men had ASIL by cytology. Adding high-risk HPV genotyping to anal cytology improved screening for AIN in women.
References
1. Hidalgo Tenorio C, Gil Anguita C, Ramirez Taboada J, et al. Prevalence and risk factors for anal squamous intraepithelial lesions (ASIL) in women living with HIV in the era of effective therapy. ICAAC 2014. September 5-9, 2014. Washington, DC. Abstract H-1641.
2. Chaturvedi AK, Madeleine MM, Biggar RJ, Engels EA. Risk of human papillomavirus-associated cancers among persons with AIDS. J Natl Cancer Inst. 2009;101:1120-1130.
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