The following is a summary of “Primary Anal Cancer Screening Results From 381 Women With Human Immunodeficiency Virus,” published in the April 2023 issue of Infectious Diseases by Liu, et al.

Women living with HIV (WWH) face an increased risk for anal cancer associated with human papillomavirus (HPV) infection. Understanding the prevalence and predictors of anal HPV disease in this population can inform guidelines for primary screening.

A total of 381 WWH who underwent anal cytology screening, high-risk HPV (hrHPV) testing, and cervical or vaginal cotesting within 6 months were identified from 2012 to 2019. Individuals with atypical squamous cells of undetermined significance (ASCUS) or worse on anal cytology underwent high-resolution anoscopy and biopsy. Adjusted logistic regression models were used to identify independent predictors of anal hrHPV, HPV16, and histological anal high-grade squamous intraepithelial lesions (aHSIL).

The prevalence of anal hrHPV, HPV16, and ASCUS or worse cytology was 61%, 13%, and 68%, respectively. Histological aHSIL was detected in 42% of WWH with ASCUS or worse anal cytology. The prevalence of genital hrHPV, HPV16, and ASCUS or worse cytology was 30%, 4%, and 28%, respectively. Genital hrHPV was a predictor of anal hrHPV (odds ratio [OR], 5.05), while genital HPV16 was a predictor of anal HPV16 (OR, 9.52). Genital hrHPV and anal HPV16 were predictors of histological aHSIL (ORs, 2.78 and 10.9, respectively).

Anal HPV disease was highly prevalent in the cohort of WWH undergoing primary screening. While genital screening results could predict anal disease, a substantial proportion of individuals had isolated anal HPV disease, indicating the need for universal anal cancer screening.