Prevalence and risk factors for anal human papillomavirus infection in human immunodeficiency virus (HIV)-positive and high- risk HIV-negative women

Little is known about the epidemiology of anal human papillomavirus (HPV) i nfection in women. We studied 251 human immunodeficiency virus (HIV)-positi ve and 68 HIV-negative women for the presence of anal HPV by use of polymer ase chain reaction (PCR) and hybrid capture. Medical and behavioral risk fa ctors were evaluated; 76% of HIV-positive and 42% of HIV-negative women wer e found to have anal HPV DNA via analysis by PCR (relative risk [RR], 1.8; 95% confidence interval [CI], 1.3-2.5). Among 200 women for whom there were concurrent anal and cervical HPV data, anal HPV was more common than cervi cal HPV in both HIV-positive (79% vs. 53%) and HIV-negative women (43% vs. 24%). By multivariate analysis of HIV-positive women, CD4(+) cell counts le ss than or equal to 200 cells/mm(3), compared with counts >500 cells/mm(3) (RR, 1.4; 95% CI, 1.1-1.5), and cervical HPV infection (RR, 1.3; 95% CI, 1. 1-1.4) were associated with anal HPV infection. Women >45 years old had red uced risk, compared with women <36 years old (RR, 0.80; 95% CI, 0.50-0.99), as did African American women (RR, 0.86; 95% CI, 0.72-1.0), compared with white women. Anal HPV infection is underrecognized in HIV-positive and high -risk HIV-negative women.