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. Author manuscript; available in PMC: 2016 Sep 1.
Published in final edited form as: Am J Obstet Gynecol. 2015 Mar 19;213(3):278–309. doi: 10.1016/j.ajog.2015.03.034

Table 4. Prevalence of abnormal anal cytology and histology in predominantly HIV- female cohorts.

Study Location Years of
study		 Sample size Population
(age)* 		Subjects with
abnormal anal
cytology		 Criteria for
HRA
(n)		 Subjects with
AIN (histology)
n (% with HRA)

  • Prevalence AIN2+ for cohort (if available)

  • Notable findings (including statistically significant independent risk factors for AIN2+)
Any
n (%)		 HSIL or
ASC-H
n (%)		 AIN1-3
n (%)		 AIN2-3
n (%)
Calore46 Brazil Not stated 49 CIN1+ by cytology (no gross anal lesions) (M=32) 29 (59) 14 (29) ….. ….. ….. …..
D'Hauwers18 Belgium 2007-2008 93 H/o abnormal cervical cytology: N=58 Normal screening: N=35 (M=30) 10 (11) 0 ….. ….. ….. …..
El Naggar 201341
El Naggar 201242 		US 2006-2010 324 IN1+ (including cervical Ca: N=4)
(HIV+: N=16)
(other immunosuppression: N=12)
(M=39)		 18 (6) 1 (0.3) All participants (324) 64 (20) 28 (9)
  • 9% prevalence of AIN2+, in the total cohort
    Risk factor for AIN1-3 OR (95% CI)
    Immunosuppression 5.75 (2.58–12.8)
    h/o VIN 3.81 (1.84–7.87)
    H/o anal sex 1.85 (1.06–3.23)

  • Probability of AIN1-3 among women who are not immunosuppressed, have no h/o VIN or h/o anal sex is 9%

  • Probability of AIN-3 among women who are immunosuppressed, have a h/o VIN and h/o anal sex is 72%

  • Performance of anal cytology to detect AIN1-3:
    (95% CI)
    Sensitivity 9.4% (0.039-0.199)
    Specificity 88.6% (0.78-0.95)
    agreement of anal cytology to histology (κ) -.0213 (-0.128-0.086)
Heraclio20 Brazil 2008-2009 324 CIN1+ (Including cervical Ca: N=26) (HIV+ : N=8) 102 (31) 10 (3) All participants (324) 13 (4) 8 (2)

  • 2% prevalence of AIN2+, in the total cohort
Jacyntho43 Brazil 2003-2004 184 IN1-3 (72% < age 40) ….. ….. All participants (184) 32 (17) 6 (3)

  • 3% prevalence of AIN2+, in the total cohort

  • Risk for AIN 1-3 by site of IN1-3 (compared with no IN1+)
    Presence of: PR= Prevalence ratio For AIN1-3 (95% CI)
    PAIN1-3 21.4 (4.6–100)
    VIN1-3 9.4 (2–44.6)
    VaIN1-3 7.8 (1.6–36.7)
    CIN1-3 7.0 (1.5–32.5)
74 No h/o IN1-3 (72% < age 40) All participants (74) 2 (3) 0
Koppe44 Brazil 2008-2010 106 IN1-3 (38) ….. ….. All participants (106) 11 (10) 5 (5)

  • 5% prevalence of AIN2+, in the total cohort
74 HIV-(no IN1-3) (M=50) All participants (74) 1 (1) 0
Park21 US 2006-2007 102 IN2+ lower genital tract (including Ca)
(HIV+: N=1)
(M=32)		 9 (9) 2 (2) Abnormal anal cytology (7) 7 (100) 0 …..
Santoso40 US 2006-2009 205 Women with genital intraepithelial neoplasia (HIV+ : N=10) 12 (6) 0 All participants (205) 25 (12) 17 (8)
  • 5% prevalence of AIN2+, in total cohort
    Performance for detection of AIN1-3 Anal cytology %(95% CI) HRA %(95% CI)
    Sensitivity 8% (2–24%) 100% (87–100%)
    Specificity 94% (89–97%) 71% (64–77%)
    PPV 15% (4–42%) 37% (24 – 44%)
    NPV 88% (82–91%) 100% (97-100%)
Likes47 US 2006-2009 310 abnormal cervical cytology or vulvar lesion (M=40) Immune-competent ….. ….. All participants (310) 61 (19) 26 (8)

  • Rates of AIN2+ comparable in immune-compromised vs. immune-competent (9% vs. 8% respectively) (p = 0.4543)

  • Rates of VIN2+ higher in immune-compromised vs. immune-competent (55% vs. 23% respectively) (p<.0001)
33 Immune-compromised1 All participants (33) 3 (9) 3 (9)
Tatti39 Argentina 2005-2011 404 Immune-competent
IN1-3
(M=30)		 ….. ….. ….. 104 (26) 16 (4)

  • CIN2,3 increased the risk of AIN1-3 regardless of immune status: OR 1.91, 95% CI (1.1-3.6)
46 Immune-compromised IN1-3
(HIV-)2
(M=40)		 All participants (46) 15 (33) 4 (9)
Valari22 Greece 2009-2011 235 IN1+
(including Ca: N=21)
(M=34)		 ….. ….. Abnormal anal cytology or positive HPV DNA or mRNA (25) 8 (32) 0

  • AIN2+ was not detected. Prevalence of AIN1/condyloma was 3% in the total cohort.

  • Low rate3 of women referred underwent HRA
Hessol 200913 US 2001-2003 185 HIV-
(WIHS)
(M=29)		 ….. ….. Abnormal anal cytology 7 (9) 2 (3)

  • 1% prevalence of AIN2+, in total population

  • See Hessol Table 3
Holly38 US 1995-1997 61 HIV-(WIHS) 5 (8) 0 ….. ….. ….. …..
Moscicki 200310 US 1996-2001 67 HIV- adolescents
(REACH)
(M=17)		 4 (6) ….. ….. ….. ….. …..
Pierangeli30 Italy 2005-2011 109 HIV- proctology clinic4
(M=42)		 38 (35) 0 ….. ….. ….. …..
Moscicki 199945 US 1994 410 HIV-family planning clinics (M=23) 16 (4) 0 Abno mal anal cytology (9) 5 (56) 2 (22)

  • 0.5% prevalence of AIN2+, in total cohort

  • Multivariate analysis – risk factors for abnormal anal cytology
    Risk factor Adjusted OR (95% CI)
    Anal HR HPV 12.28 (3.91–43.53)
    h/o cervical SIL 4.13 (1.29–4.85)
    h/o anal intercourse 6.90 (1.71–47.15)
*

Age or mean age reported when available: M = mean

HSIL = high-grade squamous intra-epithelial lesion

ASC-H = Atypical squamous cells, cannot rule out high grade

HRA = high resolution anoscopy

CIN = cervical intraepithelial neoplasia

VaIN = vaginal intraepithelial neoplasia

VIN = vulvar intraepithelial neoplasia

PAIN = perianal intraepithelial neoplasia

AIN = anal intraepithelial neoplasia

IN1+ = intraepithelial neoplasia of the lower genital tract (cervical, vaginal or vulvar), grade 1 or higher

Ca = cancer

WIHS = Women's Interagency HIV Study

REACH = Reaching for Excellence in Adolescent Care and Health

h/o = history of

1

Immune-compromised-- 16 were HIV-positive, 5 were transplant patients, 7 had lupus and 1 had diabetes, 1 had celiac Bruce disease and 1 had Crohn's disease.

2

Immune compromised by other causes—HIV- but otherwise not specified.

3

Study reports “high fallout rate” but rate not specified-- (4/19 with + HPV, and unknown of abnormal cytology)

4

Women seen at a proctology clinic with no history of HPV-related pathologies