Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Feb 1;213(3):351-60.
doi: 10.1093/infdis/jiv408. Epub 2015 Aug 12.

Incidence and Predictors of Abnormal Anal Cytology Findings Among HIV-Infected Adults Receiving Contemporary Antiretroviral Therapy

Lois J Conley  1 , Timothy J Bush  1 , Teresa M Darragh  2 , Joel M Palefsky  2 , Elizabeth R Unger  2 , Pragna Patel  1 , Martin Steinau  2 , E Milu Kojic  3 , Harold Martin  4 , E Turner Overton  5 , Susan Cu-Uvin  3 , John Hammer  6 , Keith Henry  7 , Kathleen Wood  8 , John T Brooks  1 ; SUN Study Group
Affiliations

Incidence and Predictors of Abnormal Anal Cytology Findings Among HIV-Infected Adults Receiving Contemporary Antiretroviral Therapy

Lois J Conley et al. J Infect Dis. .

Abstract

Background: Anal cancer rates are higher for human immunodeficiency virus (HIV)-infected adults than for uninfected adults. Limited published data exist characterizing the incidence of precursor lesions detected by anal cytology.

Methods: The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy was a prospective cohort of 700 HIV-infected participants in 4 US cities. At baseline and annually thereafter, each participant completed a behavioral questionnaire, and healthcare professionals collected anorectal swabs for cytologic examination and human papillomavirus (HPV) detection and genotyping.

Results: Among 243 participants with negative baseline results of anal cytology, 37% developed abnormal cytology findings (incidence rate, 13.9 cases/100 person-years of follow-up; 95% confidence interval [CI], 11.3-16.9) over a median follow-up duration of 2.1 years. Rates among men having sex with men, among women, and among men having sex with women were 17.9 cases/person-years of follow-up (95% CI, 13.9-22.7), 9.4 cases/person-years of follow-up (95% CI, 5.6-14.9), and 8.9 cases/person-years of follow-up (95% CI, 4.8-15.6), respectively. In multivariable analysis, the number of persistent high-risk HPV types (adjusted hazard ratio [aHR], 1.17; 95% CI, 1.01-1.36), persistent high-risk HPV types except 16 or 18 (aHR, 2.46; 95% CI, 1.31-4.60), and persistent types 16 or 18 (aHR, 3.90; 95% CI, 1.78-8.54) remained associated with incident abnormalities.

Conclusions: The incidence of abnormal anal cytology findings was high and more likely to develop among persons with persistent high-risk HPV.

Keywords: HIV; HPV; abnormal anal cytology; incidence; persistence.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. E. T. O. reports receiving the following support outside the submitted work: personal fees from Gilead Sciences and other support from Gilead Sciences, Vertex, AbbVie, Merck, Bristol-Meyers Squibb, and ViiV Healthcare. K. H. reports receiving grants from Gilead, GSK/ViiV, and Janssen during the conduct of the study. J. M. P. reports receiving grants and nonfinancial support from Merck; grants, personal fees, and nonfinancial support from Hologic; and personal fees from The Vax, Hera Therapeutics, and Bristol Myers Squibb outside the submitted work. T. M. D. reports receiving nonfinancial support from Hologic during the conduct of the study. H. M. reports receiving other support from Gilead Sciences outside the submitted work. All other authors report no potential conflicts.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Incidence rates and 95% confidence intervals for abnormal anal cytology findings through 5 years of follow-up among participants in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy, 2004–2011. Abbreviations: IQR, interquartile range; MSM, men who have sex with men; MSW, men who have sex with women.
Figure 2.
Figure 2.
Survival analyses for detection of incident abnormal anal cytology findings, by participant category (n = 243; A), human papillomavirus (HPV) type (n = 237; B), and persistence of HPV by year of follow-up (n = 230; C), among participants in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy, 2004–2011. Data begin with the 1-year follow-up visit because all analyses were restricted to participants with at least 1 follow-up visit. Abbreviations: MSM, men who have sex with men; MSW, men who have sex with women.
See this image and copyright information in PMC

References

    1. Howlader N, Noone A, Krapcho M, et al. SEER cancer statistics review, 1975–2010. SEER web site. 2013; http://seer.cancer.gov/statfacts/html/anus.html. Accessed 2 August 2013.
    1. Amirian ES, Fickey PA Jr, Scheurer ME, Chiao EY. Anal cancer incidence and survival: comparing the greater San-Francisco bay area to other SEER cancer registries. PLoS One 2013; 8:e58919. - PMC - PubMed
    1. Chiao EY, Krown SE, Stier EA, Schrag D. A population-based analysis of temporal trends in the incidence of squamous anal canal cancer in relation to the HIV epidemic. J Acquir Immune Defic SyndrD 2005; 40:451–5. - PubMed
    1. Patel P, Hanson D, Sullivan P, et al. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann Intern Med 2008; 148:728–36. - PubMed
    1. Diamond C, Taylor T, Aboumrad T, Bringman D, Anton-Culver H. Increased incidence of squamous cell anal cancer among men with AIDS in the era of highly active antiretroviral therapy. Sex Transm Dis 2005; 32:314–20. - PubMed

Publication types

Substances