High Prevalence of High Grade Anal Intraepithelial Neoplasia in HIV-Infected Women Screened for Anal Cancer

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.

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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.

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The Accuracy of Anal Swab–Based Tests to Detect High-Grade Anal Intraepithelial Neoplasia in HIV-Infected Patients: A Systematic Review and Meta-analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz191 ◽

2019 ◽

Vol 6 (5) ◽

Cited By ~ 3

Author(s):

Fernando Dias Gonçalves Lima ◽

Janine D Viset ◽

Mariska M G Leeflang ◽

Jacqueline Limpens ◽

Jan M Prins ◽

...

Keyword(s):

Anal Cancer ◽

Predictive Value ◽

Dna Detection ◽

Intraepithelial Neoplasia ◽

Anal Intraepithelial Neoplasia ◽

Hiv Positive ◽

High Grade ◽

Ki 67 ◽

Hpv Dna ◽

Anal Swab

Abstract Background The incidence of high-risk human papillomavirus (HR-HPV)–induced anal cancer is increasingly problematic among HIV-positive patients. Anal cancer is preceded by precursor lesions, anal intraepithelial neoplasia (AIN). AIN detection requires high-resolution anoscopy, a cumbersome and time-consuming procedure. We aggregated evidence on anal swab–based tests to detect AIN in HIV-positive patients. Methods We searched MEDLINE and EMBASE for cross-sectional studies on AIN detection with anal cytology, HR-HPV DNA detection, HPV E6/E7 mRNA analysis, and P16INK4a and Ki-67 immunostaining. Summary estimates of sensitivity and specificity were calculated using bivariate logistic regression. Cytology was reported using the terms squamous intra-epithelial lesion (SIL) for AIN and high-grade SIL (HSIL) for high-grade AIN (HGAIN). Results We included 22 studies. Using cytology with a cutoff of any SIL to detect HGAIN, we detected a sensitivity of 82% (95% CI, 74%–87%) and specificity of 45% (95% CI, 44%–66%); with the cutoff of HSIL, the sensitivity was 44% (95% CI, 45%–67%) and the specificity was 79% (95% CI, 69%-87%). The sensitivity of HPV DNA to detect HGAIN was 91% (95% CI, 82%–95%) and the specificity was 27% (95% CI, 21%–33%). For MSM, the positive predictive value (PPV) of cytology with a cutoff of any SIL was 36% (95% CI, 23%–50%) and the negative predictive value (NPV) was 87% (95% CI, 78%–93%), whereas cytology with a cutoff of HSIL had a PPV of 62% (95% CI, 50%–73%) and an NPV of 78% (95% CI, 65%–87%). The PPV of HR-HPV DNA detection was 37% (95% CI, 20%–57%) and the NPV was 87% (95% CI, 79%–93%). Conclusions Given its sensitivity, cytology with a cutoff of any SIL could be considered as a triaging method, whereas cytology with a cutoff of HSIL had better specificity and could be used for quality assurance. HR-HPV DNA detection had poor specificity and PPV, making it unsuitable for triage.

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Progression From Perianal High-Grade Anal Intraepithelial Neoplasia to Anal Cancer in HIV-Positive Men Who Have Sex With Men

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000000644 ◽

2016 ◽

Vol 59 (9) ◽

pp. 836-842 ◽

Cited By ~ 13

Author(s):

Jill Tinmouth ◽

Valentina Peeva ◽

Henok Amare ◽

Sandra Blitz ◽

Janet Raboud ◽

...

Keyword(s):

Anal Cancer ◽

Intraepithelial Neoplasia ◽

Anal Intraepithelial Neoplasia ◽

Hiv Positive ◽

High Grade ◽

Sex With Men ◽

Hiv Positive Men

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Is screening for anal cancer warranted in homosexual men?

Sexual Health ◽

10.1071/sh03019 ◽

2004 ◽

Vol 1 (3) ◽

pp. 137 ◽

Cited By ~ 24

Author(s):

Jonathan StC. Anderson ◽

Claire Vajdic ◽

Andrew E. Grulich

Keyword(s):

Anal Cancer ◽

Intraepithelial Neoplasia ◽

Anal Intraepithelial Neoplasia ◽

Screening Tests ◽

Current Evidence ◽

High Risk Population ◽

Homosexual Men ◽

High Grade ◽

Negative Consequences ◽

Recurrence Rates

Some investigators have proposed screening homosexual men for anal cancer and its probable precursor, high grade anal intraepithelial neoplasia (AIN). Using widely accepted criteria for the introduction of screening programmes, this paper reviews the current evidence for screening for this condition in this high risk population and highlights areas where additional research is required. While it is accepted that the incidence of anal cancer is at least 20 times higher in homosexual men than the general population, the natural history of anal cancer and its precise relationship with AIN is not clearly understood. Anal intraepithelial neoplasia is a very highly prevalent disease among homosexual men, but little is known about what predicts progression to invasive disease. The screening tests, exfoliate cytology and high resolution anoscopy, have a sensitivity of between 45 and 70%. Treatment options for AIN are limited by morbidity and high recurrence rates and there are no randomised controlled trials studying the efficacy of therapeutic agents or surgery for high grade AIN, although immunotherapies show very early promise. Theoretically, early detection may lead to better treatment outcomes. Studies of the potential negative consequences of screening programmes on the homosexual population are needed. The currently available data does not support the implementation of a screening programme for AIN and anal cancer in homosexual men in Australia.

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