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Lack of Association between Cervical and Anal Cytologic Abnormalities among HIV-infected Women in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy
E. Milu Kojic*1, S Cu-Uvin1, L Conley2, T Bush2, E Unger2, K Henry3, J Hammer4, E Overton5, J Palefsky6, and J Brooks2
1Brown Univ, The Miriam Hosp, Providence, RI, US; 2CDC, Atlanta, GA, US; 3Hennepin County Med Ctr, Minneapolis, MN, US; 4Denver Infectious Disease Consultants, Rose Med Ctr, CO, US; 5Washington Univ Sch of Med, St Louis, MO, US; and 6Univ of California, San Francisco, US
Background: Cervical
human papillomavirus (HPV) infections and abnormal
Pap smears are more prevalent and persistent in HIV-infected than uninfected
women, particularly in the pre-HAART era. Less is known about anal HPV
infections and abnormal Pap smears in women and whether findings in the cervix
correlate with findings in the anus.
Methods: The Study
to Understand the Natural History of HIV/AIDS (SUN) is a prospective cohort
study of 687 HIV-infected patients receiving care at clinics in Denver, Minneapolis, Providence, and St.
Louis. At baseline, all patients completed a
behavioral questionnaire and provided, among other specimens, cervical and anal
swabs for cytopathologic examination (Pap smears) and
HPV detection and genotyping.
Results: Baseline
cervical and anal HPV and Pap smear results were available for 94 women, 34%
white and 52% black. The mean age was 40 years (range 21 to 64). The median nadir CD4 count was 214
cells/mm3, current CD4 count was 405 cells/mm3,
71% were on HAART, and 40% reported a history of anal sex. The prevalence of
HPV in the cervix and anus was 86% and 93%, respectively (p = 0.08). For high-risk types (those associated with precancerous and
cancerous changes of the cervix), the
prevalence in the cervix and anus was 68% and 85%, respectively (p <0.01). The most common high-risk
types were: HPV-16 (15%), 58 (15%), and
53 (14%) in the cervix; and HPV-53 (26%), 16 (22%), and 45 (22%) in the anus.
There was no difference in the prevalence of abnormal Pap smears (atypical squamous cells of undetermined significance [ASCUS], low-
or high-grade squamous intraepithelial lesions [SIL])
between the cervix and anus, 30% and 33%, respectively (p = 0.62). Of the women, 46 (49%) had a normal Pap in both the cervix and anus, 11 (12%) had an abnormal Pap at
both locations, 20 (21%) had an abnormal anal Pap only (10 ASCUS, 8 low-grade
SIL, 2 high-grade SIL), and 17 (18%) had an abnormal cervical Pap, only. A
history of anal sex was not predictive of an abnormal anal Pap: 15 (42%) of the women with a history of anal
sex had an abnormal Pap compared with 16 (30%) of those with no history of anal
sex (p = 0.24).
Conclusions: In this cohort of
HIV-infected women, about half had abnormal Pap smears in the cervix or anus,
but there was no statistical association between presence of abnormalities at
both sites. These data support studies of anal cytologic
screening of HIV-infected women, regardless of their history of anal sex, for
the detection of abnormalities including precancerous lesions.
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