Spanish study compares anal HPV, lesion rates in women by HIV status

HIV status did not significantly affect the rate of anal high-grade intraepithelial neoplasia among women who had other risk factors for anal diseases, according to recently published data out of Spain. The researchers suggested ways to identify women who should be further evaluated for anal cancer.

About This Study

“Anal high-grade intraepithelial neoplasia and cancer in women living with HIV and HIV-negative women with other risk factors” was published online on Aug. 14, 2024, in AIDS. The lead author is Montserrat Capell-Morell, , of Atenció a la Salut Sexual i Reproductiva (ASSIR) Muntanya at the Institut Català de la Salut in Barcelona, Spain.

Key Research Findings

This single-site prospective cohort study, following women from 2014-2021, assessed the frequency of anal high-grade intraepithelial neoplasia and anal cancer in women living with HIV compared to HIV-negative women at risk for anal diseases. Among 322 participants, 202 were living with HIV. Median ages were 47-48 years for HIV-negative women and women living with HIV, respectively. Of the women living with HIV enrolled in the study, 97% were on antiretroviral treatment, and 15% met AIDS criteria.

During an average follow-up period of 36 months, baseline cytology found anal high-grade intraepithelial neoplasia in 7% of participants living with HIV and 8% of HIV-negative participants. High-resolution anoscopy was performed in 114 participants living with HIV and in 82 HIV-negative participants. Visible lesions were biopsied, resulting in a cancer diagnosis in four women, all of whom were living with HIV.

All participants with high-grade squamous intraepithelial lesions or cancer had HPV 16, a high-risk human papillomavirus genotype. Infections with high-risk genotypes were common: anal HPV 16 was detected in 17% of women living with HIV and 29% of women not living with HIV, while other high-risk HPV genotypes were detected in 34% of women with HIV and 36% of women not living with HIV. Neoplasia rates were similar between the two groups.

Discussion Highlights and Implications for Practice

Study limitations reported by the authors indicated that only a subset of participants had anal biopsies performed, and not all histological testing of biopsy samples returned clear results. Additional study weaknesses included the small sample size and heterogeneity of HIV-negative participants. The researchers also pointed out that the study was not powered to determine differences in cancer rates between the two cohorts.

Women who have had human papillomavirus-related diseases or are immunosuppressed should be screened for anal cancer, study authors recommended. They called for additional research into how and how often testing for HPV 16, anal cytology, and anoscopy should be performed in women at risk.

By Barbara Jungwirth