December 8, 2008

HIV-Positive Women More Likely to Have Precancerous Anal Lesions

HIV-positive women were more than twice as likely to have precancerous anal lesions as their HIV-negative counterparts, according to a study published in the January 2 issue of AIDS.

Recent studies have suggested that anal cancer may be more common in people with HIV. As with cervical cancer, infection with the human papillomavirus (HPV) is believed to be the primary driver behind the development of anal cancer. A number of studies have compared the rates of cervical cancer and precancerous cervical lesions between HIV-positive and HIV-negative women, and have found an increased risk for HIV-positive women. Few studies, however, have explored the comparative risk for precancerous anal lesions—called anal intraepithelial neoplasias (AIN)—in HIV-positive women.

To examine the rates of precancerous anal lesions in women, Nancy Hessol, MSPH, from the University of California in San Francisco, and her colleagues from the Women’s Interagency HIV Study (WIHS) examined 470 HIV-positive and 185 HIV-negative women, most between 31 and 50 years of age.

Just over half were smokers and just under 50 percent had ever engaged in anal sex—both being risk factors for anal lesions. It is important to note, however, that women who’ve never engaged in anal sex can get anal lesions and anal cancer, especially if they’ve had HPV infection of the vagina or cervix.

Hessol’s team found significant differences between the HIV-positive and HIV-negative women. Eighty percent of the HIV-positive women had evidence of anal HPV infection, compared with 50 percent of HIV-negative women. They also reported that HIV-positive women were 40 percent more likely to have low-grade AIN and three times as likely to have high-grade AIN as HIV-negative women. Overall, 16 percent of HIV-positive women had either low- or high-grade AIN.

Contrary to some studies of cervical cancer, a woman’s smoking history did not appear to influence the development of AIN. The factor most strongly associated with high-grade AIN was infection with strains of HPV that are associated with cancer. The factor associated with low-grade AIN was infection with any strain of HPV, both those linked to cancer and those that are not. Though the authors do not make recommendations about screening for anal lesions—such as anal Pap smears and anoscopy—HIV-positive women may wish to discuss this study and these procedures with their health care providers.

Search: human papillomavirus, HPV, anal intraepithelial neoplasia (AIN), anal cancer, cervical cancer, Nancy Hessol, UCSF

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