Elizabeth A Stier1, Shelly Y Lensing2, Teresa M Darragh3, Ashish A Deshmukh4, Mark H Einstein5, Joel M Palefsky6, Naomi Jay7, J Michael Berry-Lawhorn7,8, Timothy Wilkin9, Dorothy J Wiley10, Luis F Barroso11, Ross D Cranston12, Rebecca Levine13, Humberto M Guiot14, Audrey L French15, Deborah Citron16, M Katayoon Rezaei17, Stephen E Goldstone18, Elizabeth Chiao19,20. 1. Obstetrics and Gynecology, Boston University School of Medicine, Massachusetts. 2. Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock. 3. Department of Pathology, Mount Zion Medical Center, University of California, San Francisco (UCSF). 4. Department of Management Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston. 5. Department of Obstetrics/Gynecology and Women's Health, Rutgers-New Jersey Medical School, Newark. 6. Department of Medicine, UCSF. 7. Anal Neoplasia Clinic, Research, and Education Center, San Francisco, California. 8. Division of Hematology Oncology, UCSF. 9. Clinical Trials Unit, Department of Medicine, Cornell University, New York, New York. 10. School of Nursing, University of California, Los Angeles. 11. Department of Internal Medicine, Infectious Diseases, Wake Forest University Health Sciences, Winston-Salem, North Carolina. 12. University of Vic, Hospital Germans Trias i Pujol, Badalona, Spain. 13. Department of Surgery, Montefiore Medical Center, Bronx, New York. 14. Department of Medicine and Department of Microbiology and Medical Zoology, University of Puerto Rico School of Medicine, San Juan. 15. Division of Infectious Diseases, CORE Center/Stroger Hospital of Cook County, Chicago, Illinois. 16. Department of Pathology, Baylor College of Medicine, Houston, Texas. 17. Department of Pathology, George Washington University, Washington, District of Columbia. 18. Icahn School of Medicine at Mount Sinai, New York, New York. 19. Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine. 20. Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Abstract
BACKGROUND: Women living with human immunodeficiency virus (WLHIV) have disproportionately high rates of squamous cell carcinoma of the anus compared with the general population of women. Anal high-grade squamous intraepithelial lesions (HSILs) precede anal cancer, and accurate studies of HSIL prevalence among WLHIV in the United States are lacking. METHODS: The AIDS Malignancy Consortium 084 study was a multicenter national trial to evaluate the prevalence of and risk factors for anal HSIL in a US cohort. Eligible participants were WLHIV aged ≥18 years with no history of anal HSIL. Study participants had an examination including collection of cervical/vaginal and anal specimens, followed by high-resolution anoscopy with biopsy. RESULTS: We enrolled 256 women with evaluable anal pathology. The mean age was 49.4 years, 64% women were non-Hispanic black, 67% were former or current smokers, and 56% reported ever having anal sex with a man. The median CD4 T-cell count was 664 cells/μL. The prevalence of anal histologic HSIL (hHSIL) was 27% (95% confidence interval [CI], 22%-33%). There was a strong concordance (240/254) between local and consensus pathologists for hHSIL vs less than hHSIL (κ = 0.86 [95% CI, .79-.93]). Current CD4 count of ≤200 cells/μL was the strongest predictor of consensus anal hHSIL diagnosis (adjusted odds ratio [aOR], 10.34 [95% CI, 3.47-30.87]). History of anoreceptive intercourse was also associated with hHSIL (aOR, 2.44 [95% CI, 1.22-4.76]). CONCLUSIONS: The prevalence of anal hHSIL in WLHIV in the United States was 27% in this study where all participants received high-resolution anoscopy and biopsy.
BACKGROUND:Women living with human immunodeficiency virus (WLHIV) have disproportionately high rates of squamous cell carcinoma of the anus compared with the general population of women. Anal high-grade squamous intraepithelial lesions (HSILs) precede anal cancer, and accurate studies of HSIL prevalence among WLHIV in the United States are lacking. METHODS: The AIDS Malignancy Consortium 084 study was a multicenter national trial to evaluate the prevalence of and risk factors for anal HSIL in a US cohort. Eligible participants were WLHIV aged ≥18 years with no history of anal HSIL. Study participants had an examination including collection of cervical/vaginal and anal specimens, followed by high-resolution anoscopy with biopsy. RESULTS: We enrolled 256 women with evaluable anal pathology. The mean age was 49.4 years, 64% women were non-Hispanic black, 67% were former or current smokers, and 56% reported ever having anal sex with a man. The median CD4 T-cell count was 664 cells/μL. The prevalence of anal histologic HSIL (hHSIL) was 27% (95% confidence interval [CI], 22%-33%). There was a strong concordance (240/254) between local and consensus pathologists for hHSIL vs less than hHSIL (κ = 0.86 [95% CI, .79-.93]). Current CD4 count of ≤200 cells/μL was the strongest predictor of consensus anal hHSIL diagnosis (adjusted odds ratio [aOR], 10.34 [95% CI, 3.47-30.87]). History of anoreceptive intercourse was also associated with hHSIL (aOR, 2.44 [95% CI, 1.22-4.76]). CONCLUSIONS: The prevalence of anal hHSIL in WLHIV in the United States was 27% in this study where all participants received high-resolution anoscopy and biopsy.
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