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Prevalence of and Risk Factors for Anal High-grade Squamous Intraepithelial Lesions in Women Living with Human Immunodeficiency Virus

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 HS...

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Published in:Clinical infectious diseases 2020-04, Vol.70 (8), p.1701-1707
Main Authors: Stier, Elizabeth A, Lensing, Shelly Y, Darragh, Teresa M, Deshmukh, Ashish A, Einstein, Mark H, Palefsky, Joel M, Jay, Naomi, Berry-Lawhorn, J Michael, Wilkin, Timothy, Wiley, Dorothy J, Barroso, Luis F, Cranston, Ross D, Levine, Rebecca, Guiot, Humberto M, French, Audrey L, Citron, Deborah, Rezaei, M Katayoon, Goldstone, Stephen E, Chiao, Elizabeth
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cited_by cdi_FETCH-LOGICAL-c408t-24b2a98e7fa514efa0c446a1db8b3e57716c2237ebbb1705690cecabe3dbb7293
cites cdi_FETCH-LOGICAL-c408t-24b2a98e7fa514efa0c446a1db8b3e57716c2237ebbb1705690cecabe3dbb7293
container_end_page 1707
container_issue 8
container_start_page 1701
container_title Clinical infectious diseases
container_volume 70
creator Stier, Elizabeth A
Lensing, Shelly Y
Darragh, Teresa M
Deshmukh, Ashish A
Einstein, Mark H
Palefsky, Joel M
Jay, Naomi
Berry-Lawhorn, J Michael
Wilkin, Timothy
Wiley, Dorothy J
Barroso, Luis F
Cranston, Ross D
Levine, Rebecca
Guiot, Humberto M
French, Audrey L
Citron, Deborah
Rezaei, M Katayoon
Goldstone, Stephen E
Chiao, Elizabeth
description 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. To determine the true prevalence of anal high-grade squamous intraepithelial lesions in women living with human immunodeficiency virus in the United States, we conducted high-resolution anoscopy and biopsies on all participants in the study. The prevalence was 27%, and substantially higher than previous reports.
doi_str_mv 10.1093/cid/ciz408
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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. To determine the true prevalence of anal high-grade squamous intraepithelial lesions in women living with human immunodeficiency virus in the United States, we conducted high-resolution anoscopy and biopsies on all participants in the study. The prevalence was 27%, and substantially higher than previous reports.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciz408</identifier><identifier>PMID: 31292602</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Anal Canal ; and Commentaries ; Anus Neoplasms - epidemiology ; Female ; HIV ; HIV Infections - complications ; HIV Infections - epidemiology ; Humans ; Male ; Middle Aged ; Papillomavirus Infections - complications ; Papillomavirus Infections - epidemiology ; Prevalence ; Risk Factors ; Squamous Intraepithelial Lesions</subject><ispartof>Clinical infectious diseases, 2020-04, Vol.70 (8), p.1701-1707</ispartof><rights>The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2019</rights><rights>The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-24b2a98e7fa514efa0c446a1db8b3e57716c2237ebbb1705690cecabe3dbb7293</citedby><cites>FETCH-LOGICAL-c408t-24b2a98e7fa514efa0c446a1db8b3e57716c2237ebbb1705690cecabe3dbb7293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31292602$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stier, Elizabeth A</creatorcontrib><creatorcontrib>Lensing, Shelly Y</creatorcontrib><creatorcontrib>Darragh, Teresa M</creatorcontrib><creatorcontrib>Deshmukh, Ashish A</creatorcontrib><creatorcontrib>Einstein, Mark H</creatorcontrib><creatorcontrib>Palefsky, Joel M</creatorcontrib><creatorcontrib>Jay, Naomi</creatorcontrib><creatorcontrib>Berry-Lawhorn, J Michael</creatorcontrib><creatorcontrib>Wilkin, Timothy</creatorcontrib><creatorcontrib>Wiley, Dorothy J</creatorcontrib><creatorcontrib>Barroso, Luis F</creatorcontrib><creatorcontrib>Cranston, Ross D</creatorcontrib><creatorcontrib>Levine, Rebecca</creatorcontrib><creatorcontrib>Guiot, Humberto M</creatorcontrib><creatorcontrib>French, Audrey L</creatorcontrib><creatorcontrib>Citron, Deborah</creatorcontrib><creatorcontrib>Rezaei, M Katayoon</creatorcontrib><creatorcontrib>Goldstone, Stephen E</creatorcontrib><creatorcontrib>Chiao, Elizabeth</creatorcontrib><title>Prevalence of and Risk Factors for Anal High-grade Squamous Intraepithelial Lesions in Women Living with Human Immunodeficiency Virus</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>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. To determine the true prevalence of anal high-grade squamous intraepithelial lesions in women living with human immunodeficiency virus in the United States, we conducted high-resolution anoscopy and biopsies on all participants in the study. 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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. To determine the true prevalence of anal high-grade squamous intraepithelial lesions in women living with human immunodeficiency virus in the United States, we conducted high-resolution anoscopy and biopsies on all participants in the study. The prevalence was 27%, and substantially higher than previous reports.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>31292602</pmid><doi>10.1093/cid/ciz408</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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source Oxford Journals Online
subjects Anal Canal
and Commentaries
Anus Neoplasms - epidemiology
Female
HIV
HIV Infections - complications
HIV Infections - epidemiology
Humans
Male
Middle Aged
Papillomavirus Infections - complications
Papillomavirus Infections - epidemiology
Prevalence
Risk Factors
Squamous Intraepithelial Lesions
title Prevalence of and Risk Factors for Anal High-grade Squamous Intraepithelial Lesions in Women Living with Human Immunodeficiency Virus
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