Anal screening on HIV positive women

Greetings from CROI

High rate of HSIL on HRA in HIV positive women not meeting criteria for anal screening

Anal dysplasia in HIV positive women

Anal cancer is an uncommon cancer affecting 1.8 per 100000, although this figure is increasing in resource rich countries by 2% per year, the risk of developing anal cancer can be 10 times higher in HIV.

New York guidelines recommended that anal cytology should be taken at baseline and then annually in the following HIV-infected populations:

•Men who have sex with men

•Any patient with a history of anogenital condylomas

•Women with abnormal cervical/vulvar histology

Fanny Ita-Nagy presented a study from Icahn School of Medicine at Mount Sinai, New York

In this study from 2009 to 2014 they screened all HIV positive women who received care at the centre

Total number of women who had anal screening was 877. Out of this group 290 women were referred for high resolution anoscopy (HRA) due to high grade cytological changes.

Following HRA and anal biopsy 79 women had a histological diagnosis of HSIL and 1 woman had invasive anal squamous cell carcinoma.

In this study they also measured specific parameters, which included

Age, cervical intraepithelial neoplasia, genital warts, anal sex, smoking, HIV viral load, CD4 count.

This study concluded that 26% of the anal HSIL would have been missed if local anal screening guidelines had been followed.

Smoking was the only measured parameter that had a positive correlation with HSIL

This study recommended that the anal screening programme should be extended to all people living with HIV

HPV related high grade cervical and anal neoplasia have many parallels.

Take home message in Australia it is recommended that all HIV positive women should have an annual cervical PAP, although figures show that less than > 10% of HIV positive women who attended STI clinics actually underwent the recommended annual cervical PAP smear.