Keith Henry, MD reviewing Gaisa M et al. Clin Infect Dis 2017 Feb 1.

A substantial portion of HIV-positive women who did not meet current guidelines for anal cancer screening were found to have precancerous lesions.

Current guidelines recommend annual anal cancer screening for HIV-infected women with a history of abnormal cervical cytology or receptive anal intercourse (RAI). However, anal high-grade squamous intraepithelial lesions (HSIL) have been observed in HIV-infected women with or without those risk factors.

To determine whether current guidelines adequately identify HIV-infected women at risk for anal HSIL, investigators conducted a retrospective cohort study at a medical center where, since 2009, all HIV-infected persons were offered annual anal cytology screening, regardless of cancer risk factors. Patients with abnormal cytology were then referred for high-resolution anoscopy (HRA) with biopsy of suspicious areas.

Of 745 women who underwent screening, 403 (54%) had abnormal cytology — defined as atypical squamous cells of undetermined significance or higher grade — on either the initial or subsequent examination. Of these patients, 208 underwent HRA, which showed that 133 (64%) had some level of intraepithelial neoplasia and 49 (24%) had HSIL or invasive carcinoma. Smoking doubled the risk for HSIL. A substantial portion of HIV-positive women who did not meet current guidelines for anal cancer screening were found to have HSIL on biopsy: Among 24 women with no history of abnormal cervical cytology, 5 (21%) had HSIL histology, and among 10 women with no history of RAI, 1 (10%) had HSIL histology.

CITATION(S):

Gaisa M et al. High rates of anal high-grade squamous intraepithelial lesions in HIV-infected women who do not meet screening guidelines. Clin Infect Dis 2017 Feb 1; 64:289. 

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