Prevalence of abnormal anal cytology in women infected with HIV

Abstract

Anal cancer is a rare disease. Nevertheless, it may be a reason for concern among groups in which its incidence is increasing: those who engage in anoreceptive intercourse, promiscuous persons, and those with sexually transmitted infections (HPV and HIV). The aim of this study was to evaluate the prevalence of abnormal anal cytology in women infected with HIV seen at Hospital de Clínicas de Porto Alegre, Brazil. A cross-sectional design was used. Anal smear screening was offered to all women infected with HIV seen at the hospital's outpatient sexually transmitted infections clinic from March 2006 to March 2008. A total of 184 patients were thus enrolled. Only patients who gave written consent were included in the study. The prevalence of abnormal anal cytology was 14.1% (26 patients). Twenty-two patients presented atypical squamous cells of undetermined significance, and four exhibited low-grade intraepithelial neoplasia. Initially, abnormal anal cytology was significantly associated with age, number of pregnancies, smoking, abnormal cervical cytology, CD4⁺ < 200 cells/mm³ and hepatitis C co-infection. After adjustment, only CD4⁺ < 200 cells/mm³ and smoking were found to increase the risk of altered anal cytology. The anal Pap method described is simple and can be used for screening in cohorts of HIV-positive women who are at risk of developing anal carcinoma, mainly those with CD4⁺ counts <200 cells/mm³ and smokers.

Anal Human Papillomavirus (HPV) Prevalences and Factors Associated with Abnormal Anal Cytology in HIV-Infected Women in an Urban Cohort from Rio de Janeiro, Brazil

“…Current literature on the association between a history of receptive anal intercourse and abnormal anal cytology shows inconsistent results, 15,19,25,27 which might explain the discrepancy across population subsets in our study. Additionally, nearly half (40.8%) of the women in our study reported a history of receptive anal intercourse, comparable to reports from other studies on anal HPV and cytology among HIV-infected women in Brazil.…”

“…19,35 However, the literature documents an association between smoking and HSIL, while out study assessed potential risk factors for anal ASC-US + , which might explain the absence of a significant association in our study.…”

“…Although current CD4 + T-cell count £ 200 cells/mm 3 has been identified as a potential risk factor for abnormal anal cytology in HIV-infected women, 19,27 low nadir CD4 + count and not current CD4 + count was significant in our multivariate model. An increased conversion from Th1 to Th2 cells in HIV-infected women with high-grade lesions, as well as a defective immune-response to the HPV oncogenes E6/E7 in T cell lines derived from HIV-infected individuals has also been documented.…”

“…Additionally, nearly half (40.8%) of the women in our study reported a history of receptive anal intercourse, comparable to reports from other studies on anal HPV and cytology among HIV-infected women in Brazil. 18,19 There are little data on whether the rates of anal intercourse among HIVuninfected women differ from HIV-infected women in Brazil, and whether potential differences in these rates drive higher prevalences of abnormal anal or cervical cytology among HIV-infected women. However, a recent crosssectional study from a cervical colposcopy clinic in Vitoria, Brazil, documented that 49.1% of HIV-uninfected women with high-grade cervical dysplasia reported a history of anal intercourse, whereas only 26.5% of HIV-uninfected women with negative high-grade cervical lesions reported anal intercourse, suggesting high prevalences of anal intercourse among HIV-uninfected women as well.…”

“…17 Data on factors associated with abnormal anal cytology in HIV-infected women are scarce, particularly from low and middle-income countries. 8,[18][19][20] Very few studies in Brazil have documented the prevalence of anal HR-HPV genotypes and abnormal anal cytology in HIV-infected women. 18 19 To address this gap, we assessed anal HPV genotypes and factors associated with abnormal anal cytology in a cross-sectional study of a cohort of HIV-infected women in Rio de Janeiro, Brazil.…”