Systematic review
Gynecology
Prevalence of anal human papillomavirus infection and anal HPV-related disorders in women: a systematic review

https://doi.org/10.1016/j.ajog.2015.03.034Get rights and content

The aim of this study was to systematically review the findings of publications addressing the epidemiology of anal human papillomavirus (HPV) infection, anal intraepithelial neoplasia, and anal cancer in women. We conducted a systematic review among publications published from Jan. 1, 1997, to Sept. 30, 2013, to limit to publications from the combined antiretroviral therapy era. Three searches were performed of the National Library of Medicine PubMed database using the following search terms: women and anal HPV, women anal intraepithelial neoplasia, and women and anal cancer. Publications were included in the review if they addressed any of the following outcomes: (1) prevalence, incidence, or clearance of anal HPV infection, (2) prevalence of anal cytological or histological neoplastic abnormalities, or (3) incidence or risk of anal cancer. Thirty-seven publications addressing anal HPV infection and anal cytology remained after applying selection criteria, and 23 anal cancer publications met the selection criteria. Among HIV-positive women, the prevalence of high-risk (HR)–HPV in the anus was 16–85%. Among HIV-negative women, the prevalence of anal HR-HPV infection ranged from 4% to 86%. The prevalence of anal HR-HPV in HIV-negative women with HPV-related pathology of the vulva, vagina, and cervix compared with women with no known HPV-related pathology, varied from 23% to 86% and from 5% to 22%, respectively. Histological anal high-grade squamous intraepithelial lesions (anal intraepithelial neoplasia 2 or greater) was found in 3–26% of the women living with HIV, 0–9% among women with lower genital tract pathology, and 0–3% for women who are HIV negative without known lower genital tract pathology. The incidence of anal cancer among HIV-infected women ranged from 3.9 to 30 per 100,000. Among women with a history of cervical cancer or cervical intraepithelial neoplasia 3, the incidence rates of anal cancer ranged from 0.8 to 63.8 per 100,000 person-years, and in the general population, the incidence rates ranged from 0.55 to 2.4 per 100,000 person-years. This review provides evidence that anal HPV infection and dysplasia are common in women, especially in those who are HIV positive or have a history of HPV-related lower genital tract pathology. The incidence of anal cancer continues to grow in all women, especially those living with HIV, despite the widespread use of combined antiretroviral therapy.

Section snippets

Objective

The aim of this paper is to systematically review and to summarize the findings of publications addressing the epidemiology of anal HPV infection, anal neoplasia, and anal cancer in women.

Methods

We performed a systematic review for publications of anal HPV infection, anal histological and cytological abnormalities in women, and anal cancer in women published from January 1997 to Sept. 30, 2013. Because the publications evaluating HPV-related disease were so heterogeneous (different methodologies for

Study characteristics

A total of 60 publications were included in the review. Many of the publications were conducted in women with specific risk factors for anal cancer. Of the anal HPV prevalence publications, 10 publications specified that the population included only HIV-positive women.

Among the publications that did not specify HIV infection, 6 publications were conducted in women with a history of abnormal cervical cytology or intraepithelial neoplasia (IN) 1 or greater of the lower genital tract, 1

Results of anal cytology and histology in women

Table 3, Table 4 summarize publications that evaluated abnormal anal cytology and/or histology in women. Ten publications reported results for only women living with HIV,11, 12, 14, 15, 32, 33, 34, 35, 36, 37 3 publications reported comparative results for both HIV-positive and HIV-negative women.10, 13, 38 Twelve publications evaluated study cohorts of women with abnormal cervical cytology or IN1+ of the lower genital tract. Six of these 12 publications included a small number of HIV-positive

Main findings

Our systematic review of the literature revealed that anal HPV infection in women is prevalent in general and comparable with rates of cervical HPV infection. In particular, HIV-positive women and women with HPV-related pathology of the lower genital tract were found to have high rates of HR HPV infection, high rates of high-grade AIN 2 or greater on biopsy, and elevated rates of anal cancer. Of note, few longitudinal publications evaluating anal HR HPV infection and AIN 2 or greater on women

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    This study was supported by National Institutes of Health–funded program grant R01 CA163103; the Center for Innovations in Quality, Effectiveness, and Safety (Center for Innovation no. 13-413); the Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; and National Institutes of Health–funded AIDS Malignancy Consortium grant U01 CA121947.

    The authors report no conflict of interest.

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