Rates of Anal Cancer Precursors High in Women Living With HIV

The prevalence of anal high-grade squamous intraepithelial lesions (HSILs), which precede anal cancer, is high among women living with HIV (WLHIV) in the United States, according to a study published online July 11 in Clinical Infectious Diseases.

Elizabeth A. Stier, M.D., from the Boston University School of Medicine, and colleagues used data from the multicenter AIDS Malignancy Consortium 084 study to evaluate the prevalence of and risk factors for anal HSILs among 256 WLHIV (median age, 49.4 years). Participants had an examination that included collection of cervical/vaginal and anal specimens and high-resolution anoscopy with biopsy.

The researchers found a median CD4 T-cell count of 664 cells/µL. Histologic examination showed a prevalence of anal HSIL of 27 percent. There was a strong concordance (240 of 254) between local and consensus pathologists for histologic HSIL. The strongest predictor of consensus anal histologic HSIL diagnosis was current CD4 count of ≤200 cells/µL (adjusted odds ratio, 10.34). There was also an association between history of anoreceptive intercourse and histologic HSIL (adjusted odds ratio, 2.44).

"The high prevalence of anal cancer precursors and invasive anal cancer among women living with HIV calls for greater screening in this population," Stier said in a statement. "Because optimal screening strategies are still not yet known, prevention of anal cancer among this population should focus on identifying cost-effective strategies for the detection and management of anal cancer precursors."

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