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. 2017 Jul 1;75(3):e59-e64.
doi: 10.1097/QAI.0000000000001300.

Prevalence of Anal HPV and Anal Dysplasia in HIV-Infected Women From Johannesburg, South Africa

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Prevalence of Anal HPV and Anal Dysplasia in HIV-Infected Women From Johannesburg, South Africa

Bridgette J Goeieman et al. J Acquir Immune Defic Syndr. .
Free PMC article


Background: Anal cancer is a relatively common cancer among HIV-infected populations. There are limited data on the prevalence of anal high-risk human papillomavirus (HR-HPV) infection and anal dysplasia in HIV-infected women from resource-constrained settings.

Methods: A cross-sectional study of HIV-infected women aged 25-65 years recruited from an HIV clinic in Johannesburg, South Africa. Cervical and anal swabs were taken for conventional cytology and HR-HPV testing. Women with abnormal anal cytology and 20% of women with negative cytology were seen for high-resolution anoscopy with biopsy of visible lesions.

Results: Two hundred women were enrolled. Anal HR-HPV was found in 43%. The anal cytology results were negative in 51 (26%); 97 (49%) had low-grade squamous intraepithelial lesions (SIL), 32 (16%) had atypical squamous cells of unknown significance, and 19 (9.5%) had high-grade SIL or atypical squamous cells suggestive of high-grade SIL. On high-resolution anoscopy, 71 (36%) had atypia or low-grade SIL on anal histology and 17 (8.5%) had high-grade SIL. Overall, 31 (17.5%) had high-grade SIL present on anal cytology or histology. Abnormal cervical cytology was found in 70% and cervical HR-HPV in 41%.

Conclusions: We found a significant burden of anal HR-HPV infection, abnormal anal cytology, and high-grade SIL in our cohort. This is the first study of the prevalence of anal dysplasia in HIV-infected women from sub-Saharan Africa. Additional studies are needed to define the epidemiology of these conditions, as well as the incidence of anal cancer, in this population.

Conflict of interest statement

Conflicts of Interest: There are no other relevant conflicts of interest.


Figure 1
Figure 1. High resolution anoscopy (HRA) disposition
This shows the referral of participants to high resolution anoscopy (HRA), number of procedures completed and HRA results. NILM=no evidence of intraepithelial lesions or malignancy; LSIL= low grade squamous intraepithelial lesions; HSIL=high grade squamous intraepithelial lesions.

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