The EVVA Cohort Study: Anal and Cervical Type-Specific Human Papillomavirus Prevalence, Persistence, and Cytologic Findings in Women Living With HIV

Pokomandy, Alexandra de; Kaufman, Elaina; Castro, Christina De; Mayrand, Marie‐Hélène; Burchell, Ann; Klein, Marina B.; Charest, Louise; Auger, Manon; Rodrigues-Coutlée, Sophie; Coutlée, François; Côté, Pierre; Balso, Lina Del; Fernet, Mylène; Ghattas, Georges; Klein, Marina B.; Lalonde, Richard; LeBlanc, Raymond P.; Lessard, Bernard; Loutfy, Mona; Marcus, Victoria; Mayrand, MH; Muňoz, Marie; Potter, Martin; Preziosi, Helen; Rouleau, Danielle; Routy, Jean‐Pierre; Trottier, Helen; Williamson, Tyler

doi:10.1093/infdis/jix273

Cited by 16 publications

(12 citation statements)

References 46 publications

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“…Similar to prior studies, we found that abnormal anal cytology is more common than abnormal cervical cytology [15]. Cambou et al screened 863 HIV-infected women and found that 30.9% had abnormal anal cytology compared with 22.4% with abnormal cervical cytology [21]. De Pokomandy et al reported that in their Canadian cohort of 151 HIV-infected women, 36.7% had abnormal anal cytology, compared with 24.3% with abnormal cervical cytology [20].…”

Section: Discussionsupporting

confidence: 88%

Prevalence of and Risk Factors for Anal High-grade Squamous Intraepithelial Lesions in Women Living with Human Immunodeficiency Virus

Stier

Lensing

Darragh

et al. 2019

Clinical Infectious Diseases

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Background Women living with human immunodeficiency virus (WLHIV) have disproportionately high rates of squamous cell carcinoma of the anus compared with the general population of women. Anal high-grade squamous intraepithelial lesions (HSILs) precede anal cancer, and accurate studies of HSIL prevalence among WLHIV in the United States are lacking. Methods The AIDS Malignancy Consortium 084 study was a multicenter national trial to evaluate the prevalence of and risk factors for anal HSIL in a US cohort. Eligible participants were WLHIV aged ≥18 years with no history of anal HSIL. Study participants had an examination including collection of cervical/vaginal and anal specimens, followed by high-resolution anoscopy with biopsy. Results We enrolled 256 women with evaluable anal pathology. The mean age was 49.4 years, 64% women were non-Hispanic black, 67% were former or current smokers, and 56% reported ever having anal sex with a man. The median CD4 T-cell count was 664 cells/μL. The prevalence of anal histologic HSIL (hHSIL) was 27% (95% confidence interval [CI], 22%–33%). There was a strong concordance (240/254) between local and consensus pathologists for hHSIL vs less than hHSIL (κ = 0.86 [95% CI, .79–.93]). Current CD4 count of ≤200 cells/μL was the strongest predictor of consensus anal hHSIL diagnosis (adjusted odds ratio [aOR], 10.34 [95% CI, 3.47–30.87]). History of anoreceptive intercourse was also associated with hHSIL (aOR, 2.44 [95% CI, 1.22–4.76]). Conclusions The prevalence of anal hHSIL in WLHIV in the United States was 27% in this study where all participants received high-resolution anoscopy and biopsy.

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Section: Discussionsupporting

confidence: 88%

Prevalence of and Risk Factors for Anal High-grade Squamous Intraepithelial Lesions in Women Living with Human Immunodeficiency Virus

Stier

Lensing

Darragh

et al. 2019

Clinical Infectious Diseases

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“…As chronic HPV infections in particular with multiple and high‐risk HPV represent a risk factor for AIN and anal carcinoma, subjects were clinically examined for signs of an HPV infection such as condylomata acuminata . Anal condyloma was significantly associated with abnormal screening results ( P = 0.045).…”

Section: Resultsmentioning

confidence: 99%

Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

Todorova

Schwierzeck

Turek

et al. 2019

Acad Dermatol Venereol

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Background Incidence of anal carcinoma is increased in people living with HIV (PLWH). Due to the improved life expectancy in PLWH, identifying appropriate prevention strategies for non‐AIDS‐defining cancer types such as anal carcinoma has become a priority in managing PLWH today. Objective We aimed to evaluate anal cytology assessment as screening tool for anal dysplasia and/or carcinoma in PLWH, regardless of gender or sexual orientation. Additionally, we investigated the correlation between cancer risk factors and abnormal screening results in our patient cohort. Methods People living with HIV from the Interdisciplinary HIV Centre of the University Hospital rechts der Isar in Munich, Germany (IZAR), were screened for anal carcinoma by single cytobrush examination and anal Papanicolaou (PAP) smear assessment from 2013 to 2015. Patients with abnormal PAP smear result were offered a follow‐up examination after 12 months. Differences between two groups were tested for statistical significance using Student's t‐test and Mann–Whitney U‐test, as appropriate. Results In total, 101 PLWH were included. 26.7% of subjects (n = 27) were PAP IIID, and 9.9% (n = 10) were PAP IVa. Seven female subjects had an abnormal finding at screening. Smoking was significantly associated with abnormal findings at screening (P = 0.005). In addition, our study found an association between sexually transmitted infections (STI) and anal dysplasia. Condylomata acuminata were increased in subjects with PAP IIID/PAP IVa (P = 0.045). Reactive syphilis serology was found to be significantly associated with abnormal screening results (P = 0.016), respectively. Conclusion Our results demonstrate that smoking and two common STIs, condylomata acuminata and syphilis, are risk factors associated with advanced anal intraepithelial neoplasia (AIN) stages in our PLWH cohort. While further analysis is needed to determine diagnostic guidelines concerning AIN in PLWH, these results suggest that interdisciplinary lifestyle prevention strategies are required to reduce the risk factors for AIN in PLWH in an outpatient setting.

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“…Processed cervicovaginal (n = 335) and anal (n = 75) specimens that had been collected between 2007 and 2013 from 410 participants (397 women, 13 men) in four cohort studies and one clinical trial were retrieved from processed samples stored at −80°C. [24][25][26][27][28] In each of these five studies, all participants provided written informed consent for HPV testing. Studies were approved by the local research ethics committees of participating institutions.…”

Section: Clinical Specimensmentioning

confidence: 99%

Human papillomavirus genotype concordance between Anyplex II HPV28 and linear array HPV genotyping test in anogenital samples

Coutlée

Pokomandy

Burchell

et al. 2022

Journal of Medical Virology

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Anyplex II HPV‐28 (HPV‐28) can detect individually 28 HPV genotypes. We assessed the agreement between linear array HPV genotyping (LA‐HPV) and HPV‐28 for detection of 27 HPV genotypes in 410 stored anogenital samples (75 anal samples, 335 physician‐collected cervical samples) collected over 5 years from 410 individuals (13 men, 397 women), including 202 HIV‐seropositive individuals. HPV DNA was detected in 393 (95.9%, 95% confidence interval [CI]: 93.4–97.4) and 382 (93.2%, 95% CI: 90.3–95.3) samples with HPV‐28 and LA‐HPV (p = 0.13), respectively, for a good agreement of 96.3% (κ = 0.65). Of the 10503 HPV typing results, 10195 (780 positive, 9577 negative) were concordant, for an agreement of 97.1% (95% CI: 96.7–97.4) and an excellent of κ = 0.82 (95% CI: 0.80–0.84). The mean type‐specific concordance for 27 genotypes was 97.0%, 95% CI: 95.8–98.5 (κ = 0.86 ± 0.07, 95% CI: 0.83–0.88). Excellent agreement was obtained individually for all high‐risk genotypes (κ = 0.81–0.97) and for most other genotypes except for types 42, 44, 54, 68, and 69. The mean number of types per sample in discordant samples detected with LA‐HPV (3.0, 95% CI: 2.7–3.4) was greater than in concordant samples (1.4, 95% CI: 1.3–1.5; p< 0.001). In conclusion, HPV‐28 compared favorably with LA‐HPV, but was more frequently positive for HPV42 and HPV68.

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The EVVA Cohort Study: Anal and Cervical Type-Specific Human Papillomavirus Prevalence, Persistence, and Cytologic Findings in Women Living With HIV

Cited by 16 publications

References 46 publications

Prevalence of and Risk Factors for Anal High-grade Squamous Intraepithelial Lesions in Women Living with Human Immunodeficiency Virus

Prevalence of and Risk Factors for Anal High-grade Squamous Intraepithelial Lesions in Women Living with Human Immunodeficiency Virus

Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

Human papillomavirus genotype concordance between Anyplex II HPV28 and linear array HPV genotyping test in anogenital samples

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