12. Prevalence of and risk factors for abnormal anal cytology in an HIV colposcopy clinic

Abstract

Background: HIV-positive women with cervical dysplasia are at increased risk of anal dysplasia. Anal cancer screening may be an important prevention strategy. Recommendations for care are derived from studies on men who have sex with men, while limited information is available on women. Our aim was to determine the prevalence of and risk factors for abnormal anal cytology in HIV-positive women with established cervical human papillomavirus (HPV) infection. Methods: Anal Pap smear screening was offered to women in an HIV colposcopy clinic at an urban, university hospital as part of routine care. Variables examined included demographics, smoking, rectal symptoms, receptive anal intercourse, CD4 count, viral load, HAART, cervical Pap and biopsy results. Results: 124 anal Pap smears were performed from May 2012 to June 2013. The mean age of patients was 44.1 (s.d. 10.8), and the majority was black (80%). 114 (92%) anal Pap smears were abnormal: 67 (54%) ASCUS, 41 (33%) LSIL, 3 (2%) ASC-H, and 3 (2%) HSIL. The only statistically significant variable was CD4 count. The mean CD4 count of patients with LSIL, ASC-H, or HSIL anal Pap results was 407 and 522 (P ≤ 0.05) for those patients with normal or ASCUS results. Conclusions: Women attending an HIV colposcopy clinic are at high risk for abnormal anal cytology, especially women with lower CD4 counts. Our data supports screening in a high-risk colposcopy clinic for HIV-positive women as standard of care, particularly in South Florida, where HIV/AIDS rates are the highest in the country.