PREVALENCE OF ANAL HUMAN PAPILLOMAVIRUS INFECTION AND ANAL CYTOLOGIC ABNORMALITIES IN HIV-SEROPOSITIVE WOMEN

Objective: To determine the prevalence of anal human papillomavirus (H PV) infections and anal cytologic abnormalities in HIV-seropositive an d HIV-seronegative women. Design: This cross-sectional study of a coho rt of women with known HIV serostatus involved a standardized intervie w and a gynecologic examination, including a cytologic evaluation of t he cervix and anus. Anal swabs were tested for HPV DNA using the Hybri d Capture assay. Setting: Two HIV/AIDS clinics, a sexually transmitted disease clinic, a methadone clinic and women enrolled in a study of H IV heterosexual transmission in the greater New York City metropolitan area. Patients: One hundred and two HIV-seropositive and 96 HIV-seron egative women were selected from an ongoing study of the gynecologic m anifestations of HIV infection. Main outcome measures: Detection of an al HPV DNA and anal cytologic abnormalities. Results: Anal cytologic a bnormalities were detected in 27 (26%) of the 102 HIV-seropositive wom en and in six (7%) of 96 HIV-seronegative women. Five (5%) of the anal smears from the HIV-seropositive women and one (1%) from the HIV sero negative women had low-grade anal intra-epithelial neoplasia. The rema inder of the anal cytologic abnormalities were classified as mild squa mous cytologic atypia. HPV DNA was detected in 30 (29%) of 102 HIV-ser opositive and two (2%) of 96 HIV-seronegative women. Of the 33 patient s with anal cytologic abnormalities, 19 (58%) had anal HPV DNA detecte d as compared to 13 (8%) of 160 women without cytologic abnormalities (P < 0.001). In a multivariate logistic regression analysis, HIV-serop ositivity was found to be an independent risk factor for both anal HPV infection and anal cytologic abnormalities and the strength of the as sociation was greater in women with lower CD4+ T-lymphocyte counts. Co nclusion: The prevalence of both anal cytologic abnormalities and anal HPV infection are significantly increased in HIV-seropositive women.