Importance of anal cytology and screening for anal dysplasia in individuals living with HIV with an emphasis on women

Cancer Cytopathol. 2019 Jun;127(6):407-413. doi: 10.1002/cncy.22151. Epub 2019 May 30.

Abstract

Background: The incidence of squamous cell carcinoma of the anal canal has been increasing in high-risk populations. To the authors' knowledge, there is no international consensus regarding screening for squamous cell carcinoma of the anal canal, but screening is commonly comprised of a Papanicolaou (Pap) test in combination with digital anorectal examination followed by high-resolution anoscopy if necessary. The current study focused on individuals living with HIV and particularly on women living with HIV.

Methods: In this 5-year retrospective study, the authors identified 5982 Pap tests, 1848 of which had follow-up biopsy within 6 months. The rate of atypical squamous cells of undetermined significance was 42%, and approximately 38.1% of cases with this interpretation were diagnosed as high-grade squamous intraepithelial lesions on follow-up biopsy. In addition, 82 women with anal cytology had long-term follow-up (>10 years) available.

Results: The authors investigated a relationship between cervicovaginal human papillomavirus (HPV) results, cervical pathology, CD4 T-cell count, and CD4/8 ratio with the anal cytology interpretation. A statistical correlation was noted between the CD4 count and the CD4/8 ratio and the presence of anal dysplasia. Nearly one-half of the women without cervicovaginal HPV positivity presented with anal dysplasia.

Conclusions: The results of the current study demonstrated that, among women living with HIV, screening for anal dysplasia should not be eschewed, regardless of lower genital tract pathology and/or HPV status. To the authors' knowledge, the current study is the largest reported retrospective anal cytology cohort in individuals living with HIV.

Keywords: CD4 count; HIV; anal Papanicolaou test; atypical squamous cells of undetermined significance (ASCUS); human papillomavirus (HPV) in women; immunosuppression.

MeSH terms

  • Anal Canal / cytology
  • Anal Canal / diagnostic imaging
  • Anal Canal / pathology*
  • Anus Neoplasms / diagnosis*
  • Anus Neoplasms / immunology
  • Anus Neoplasms / pathology
  • Anus Neoplasms / virology
  • Atypical Squamous Cells of the Cervix / pathology
  • Consensus
  • Digital Rectal Examination
  • Female
  • Follow-Up Studies
  • HIV Infections / complications*
  • HIV Infections / immunology
  • Humans
  • Male
  • Mass Screening / standards
  • Middle Aged
  • Papanicolaou Test / standards
  • Papillomaviridae / immunology
  • Papillomaviridae / isolation & purification
  • Papillomavirus Infections / diagnosis*
  • Papillomavirus Infections / immunology
  • Papillomavirus Infections / pathology
  • Papillomavirus Infections / virology
  • Practice Guidelines as Topic
  • Precancerous Conditions / diagnosis*
  • Precancerous Conditions / immunology
  • Precancerous Conditions / pathology
  • Precancerous Conditions / virology
  • Proctoscopy / standards
  • Retrospective Studies
  • Sex Factors