High Rates of Anal HSIL in HIV-infected Women who do not Meet Screening Guidelines

Abstract

Background:

HIV-infected women have a higher burden of anal high-grade intraepithelial lesions (HSIL) and anal cancer (AC) compared to HIV-uninfected women. Guidelines for AC screening in this population are heterogeneous. Here we report outcomes and risk factors for anal HSIL following implementation of universal AC screening offered to all HIV-infected women.

Methods:

Data from women who underwent AC screening with anal cytology from April 2009 to July 2014 were analyzed. Routine clinical data included anal and cervical cytology, demographic/behavioral data, and high-resolution anoscopy (HRA) results. We evaluated the association of cytology with HRA results, predictors of HSIL pathology, and compared rates of HSIL pathology among women meeting screening guidelines to those who did not.

Results:

745 HIV-infected women were screened with anal cytology. 39% had abnormal anal cytology on initial screen and 15% on secondary screen. 208 women underwent HRA following abnormal anal cytology. HSIL was found in 26% and 18% of anal biopsies following initial and secondary screen respectively. One woman had AC. Cigarette smoking more than doubled HSIL risk. Among women who underwent AC screening despite not meeting existing guideline criteria, 21% and 10% respectively were found to have HSIL on biopsy. Neither meeting criteria for screening nor history of receptive anal sex were significantly associated with HSIL.

Conclusion:

Anal HSIL is common in HIV-infected women. Substantial numbers of HSIL would have been missed by strictly adhering to existing AC screening guidelines. These results support routine screening of all HIV-infected women regardless of HPV history or sexual practices.