A new study by researchers at Montefiore Medical Center reveals that the incidence of anal carcinoma (AC) is increasing among HIV-positive women.
The study entitled "High Prevalence of High Grade Anal Intraepithelial Neoplasia in HIV-Infected Women Screened for Anal Cancer" will appear in the Journal of Aids on May 1st, and was conducted from March 2008 to December 2010.
Mark H. Einstein, M.D., M.S., Director of Clinical Research, Division of Gynecologic Oncology at Montefiore Medical Center and Professor at Albert Einstein College of Medicine, explained:
"Anal cancer was widely associated with HIV-Infected men who have sex with men. But now, this study reveals anal precancerous disease in a high proportion of women with HIV."
The researchers examined 715 asymptomatic HIV-Infected women and found that 10.5% showed some form of anal disease and around 33% of them were identified as true pre-cancerous disease. According to the researchers, this is likely because HIV promotes human papillomavirus (HPV) persistence which consequently, is known to be responsible for nearly all anal cancers. In addition, individuals infected with HIV also have a higher risk of developing several other HPV-associated neoplasms.
Although antiretroviral therapy (ART) has been implemented, the incidence of anal cancer has been rising. ART has not been demonstrated to consistently change the course of HPV-associated anogenital disease.
Participants of the study were Montefiore patients in the Bronx. The Bronx has one of the highest HIV prevalence rates in the country. According to data, 1.8% of individuals in the Bronx is known to be infected with HIV, this figure represents 3% of the total number of HIV patients in the United States.
Montefiore is the largest provider of medical services in the Bronx for individuals living with HIV. The center screens all HIV-infected patients for anal cancer with annual anal cytology.
Due to the findings of this study, the team advises that all HIV-positive women who have any abnormal anal cytology, particularly those with poorly controlled HIV, be referred for high resolution anoscopy. Women with poorly controlled disease are at a higher risk for harboring a high-grade AIN than women who are well controlled.
In addition, anal screening should be considered for all men and women infected with HIV. According to the researchers, as the prevalence of high-grade anal disease is lower in women with well-controlled HIV, other strategies, such as inclusion of HPV testing, may be useful for anal carcinoma screening.
As the prevalence rates appear to be significantly higher in men, this risk stratification might prove to be different for women. Furthermore, measures to increase routine anal carcinoma screening should be taken into consideration, due to the high rate of high-grade anal pre-cancerous lesions in screened HIV-infected women and an aging population of HIV-infected patients.
According to the researchers, the pre-cancerous legion can be removed (depending on the size) before it develops into cancer and save lives.
Written By Grace Rattue
Montefiore Medical Center