Although cases of anal cancer are increasing in both men and women in the U.S., anal cancer is twice as common in women than in men, according to researchers in that country. Researchers in San Francisco conducted a study among women with HIV and women who were at high risk for HIV infection to find out about their risk of anal cancer.
The profile of women in this study was as follows:
In addition to all the usual tests, women in this study also had cells from their anus removed for analysis. Testing to detect human papillomavirus (HPV) — the cause of cervical and some anal cancers — was done with PCR . To measure the amount of HPV, technicians used another test called a "hybrid capture" assay.
Technicians analysing cell samples found the following:
Although there are many types of HPV, some types such as HPV 16 are highly associated with the development of cervical and anal cancers. Among HIV positive women, the most commonly detected type was HPV 16, found in 15% of the women. As many as 35% of the women had HPV of an "unknown" type.
The researchers found that the following factors were involved with the detection of HPV in samples of anal cells:
Among HIV positive women who had samples taken from both their cervix and anus, technicians found the following:
Among HIV negative women the results were as follows:
In general, technicians found different types of HPV in the cervix compared to samples from the anus.
The findings from this relatively large study confirm those from two relatively smaller studies — that anal HPV infection is common in women at high risk for or who have HIV infection. High levels of HPV were found in women who were HIV positive and who also had low CD4+ cell counts. Women with anal HPV were also likely to have abnormal and precancerous cells in the anus.
Researchers could not measure the impact of highly active antiretroviral therapy (HAART) on their ability to detect HPV. Further work on anal HPV in women needs to be conducted. Since the women in this study largely denied having anal sex, the researchers are not sure how HPV entered their anus. The results from this study suggest that HIV positive women may benefit from regular anal Pap smears, but this needs to be confirmed in studies.
REFERENCES:
1. Olofinlade O, Adeonigbagbe O, Gualtieri N, et al. Anal carcinoma: a 15-year retrospective analysis. Scandanavian Journal of Gastroenterology 2000 35(11):1194-1199.
2. Frisch M, Biggar RJ, Goedert JJ. Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Journal of the National Cancer Institute 2000;92(18):1500-1510.
3. Palefsky JM, Holly EA, Ralston ML, et al. Prevalence and Risk Factors for Anal Human Papillomavirus Infection in Human Immunodeficiency Virus (HIV)-Positive and High-Risk HIV-Negative Women. Journal of Infectious Diseases 2001;183(3):383-39.
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