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Background:  HPV infection is strongly associated with cervical and anal dysplasia and malignancy in HIV-infected individuals. While routine cervical screening is recommended in women, the optimal use of anal PAP screening remains undefined. We sought to correlate the results of cervical and anal PAP screening obtained in our clinic.

Methods:  Results of cervical and anal Pap specimens obtained during routine care of HIV-positive women between January 2000 and July 2004 were collected from the pathology database at San Francisco General Hospital. Where available, reports of biopsies from high-resolution anoscopy and colposcopy were also collected. Specimens were considered to be “paired” if they were collected within a 6-month interval. Results were scored as normal, atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intra-epithelial lesion (LSIL), high-grade squamous intra-epithelial lesion (HSIL), or carcinoma in situ (CIS), in order of increasing atypia. Gender, age, CD4 counts, viral loads, and ART were extracted from the medical record.

Results:  Results were available from 161 women:  217 cervical and 268 anal Pap specimens. Of the cervical Pap results, 154 (71%) were normal, 26 (12%) had ASCUS, 29 (13%) had LSIL, 8 (4%) had HSIL, and none had CIS. Of the anal Pap results, 155 (58%) were normal, 70 (26%) had ASCUS, 31 (12%) had LSIL, 12 (4%) had HSIL, and none had CIS. Of the 214 paired cervical and anal Pap results, 112 (52%) demonstrated concordant results. Among the 102 discordant paired samples, the cervical specimen showed more atypia in 43, while the anal specimen showed more atypia in 59. Among the 151 normal cervical Pap results, the paired anal Pap was abnormal in 55 (36%). In the 26 paired anal Pap and anal biopsy specimens, anal Pap demonstrated a sensitivity of 94.7% and a specificity of 42.8% in predicting abnormal anal biopsy results.

Conclusions:  Abnormal cervical and anal Pap results are common among HIV-positive women in our clinic. The high frequency of discordance between cytologic findings on anal and cervical Pap smears suggests that each offers independent information and both should be evaluated in the routine health screening of HIV-infected women.  The high sensitivity of anal Pap in this small number of women supports its use an effective screening tool but warrants further study.

Keywords: HPV; anal dysplasia; cervical dysplasia