Epidemiology, natural history and risk factors for anal intraepithelial neoplasia

Studies conducted in HIV-seropositive individuals have enhanced our understanding of the natural history of anal intraepithelial neoplasia (AIN) and of factors predictive of progression to high-grade AIN, the immediate precursor to anal cancer. AIN is frequently detected in HIV-seropositive individuals. Factors that increase the risk for AIN include HIV infection, low current or nadir blood CD4+ cell counts, receptive anal intercourse, oncogenic human papillomavirus (HPV) infection, persistent anal HPV infection, multiple HPV type infections and high anal HPV viral load. This review confirms the importance of high-grade AIN in HIV-seropositive individuals and HIV-seronegative men having sex with men.

Download Full-text

7. High prevalence of human papillomavirus (HPV) infection and high-grade anal intraepithelial neoplasia in HIV-seropositive women, the EVVA study

Sexual Health ◽

10.1071/shv10n6ab7 ◽

2013 ◽

Vol 10 (6) ◽

pp. 573

Author(s):

Francois Coutlée ◽

Sophie Rodrigues-Coutlée ◽

Marie Munoz ◽

Marie Helene Mayrand ◽

Louise Charest ◽

...

Keyword(s):

Confidence Interval ◽

Intraepithelial Neoplasia ◽

Hpv Infection ◽

Anal Intraepithelial Neoplasia ◽

High Grade ◽

Women Living With Hiv ◽

Increased Risk ◽

High Prevalence ◽

Living With Hiv ◽

Hiv Seropositive

Background Women living with HIV are at increased risk of anal HPV infection, anal intraepithelial neoplasia (AIN) and anal cancer. This study will describe the burden of infection and of high-grade AIN (AIN-2,3) in a population of HIV-infected women living in Montreal, Canada. Methods: HIV-seropositive women aged ≥18 years old are recruited in the cohort study EVVA. Participants are followed every 6 months for 2 years with questionnaires, cervical/anal HPV testing, cervical/anal cytology and high-resolution anoscopy (HRA). Results: Of the 116 first participants, 88 (75.9%, 95% confidence interval (CI) 67.3–82.8) were infected by HPV in the anal canal. In contrast, 58 of these participants (50%, 95% CI 41.1–59.0) had cervical HPV infection). The most frequent types were HPV16 (n = 19), HPV51 (n = 18), HPV81 and HPV62 (n = 15 each), and HPV45 and HPV58 (n = 14 for each). An average of 2.3 ± 3.1 HPV types (median of 1) were detected per anal sample. Of the 89 participants with satisfactory cytology, 5 had high-grade squamous intraepithelial lesions. HRA from 95 women revealed 17 AIN2,3 (17.9%, 95% confidence interval (CI) 11.4–26.9), 43 AIN1 (45.3%, 95% CI 35.6–55.3), and only 35 without AIN (36.8%, 95% CI 27.8–46.9). Biopsies from 4 women gave undetermined results. Conclusions: Our study revealed that anal HPV infection was more frequently detected than cervical infection in HIV-seropositive women. Prevalent AIN2,3 is a significant problem in women infected with HIV. Prospective follow-up of women with AIN1 will disclose the proportion of women with progressive AIN.

Download Full-text

Vroegtijdige opsporing van voorstadia van een anaal carcinoom bij hiv-seropositieve patiënten

Tijdschrift voor Geneeskunde ◽

10.47671/tvg.77.21.129 ◽

2021 ◽

Author(s):

E. GÖKCE ◽

J. GELDOF ◽

P. ROELANDT ◽

J. VAN DORPE ◽

S. CALLENS ◽

...

Keyword(s):

Anal Cancer ◽

Digital Rectal Examination ◽

Intraepithelial Neoplasia ◽

Hpv Infection ◽

High Grade ◽

Anal Squamous Cell Carcinoma ◽

Increased Risk ◽

High Prevalence ◽

Risk Patients ◽

Hiv Seropositive

Early detection of precursor lesions of anal cancer in HIV-seropositive patients Although anal cancer is rare in the overall population, its incidence is increasing in the last decades. Especially HIV-seropositive patients have an increased risk of developing anal squamous cell carcinoma (SCC), mainly because of the high prevalence of high-grade anal intraepithelial neoplasia (AIN) among these patients. High-grade AIN is a precursor lesion for anal SCC associated with human papillomavirus (HPV) infection. Despite the lack of direct evidence demonstrating that AIN identification reduces the risk of anal cancer, experts think that screening and treatment of high-risk patients will prevent the disease. This article aims to review the current literature about AIN and discusses the screening options, including digital rectal examination, anal cytology and high-resolution anoscopy.

Download Full-text