5 - Pooled analysis of HPV infection in paired anal and cervical samples, by HIV status

Abstract

Background In light of HPV16's unique carcinogenicity in the anus, knowledge of anal HPV16 prevalence may be a useful surrogate for stratifying groups of women at differing anal cancer risk based on routinely available cervical cancer screening outcomes. Methods 47 relevant studies including 12,000+ samples were identified in PubMed up to March, 2018, Collaborators were invited to share individual-level data on at least age, and type-specific HPV infection in paired cervical and anal samples, by HIV status. Results The pooled dataset currently includes 4,729 HIV-negative and 968 HIV-positive women. Among HIV-negative women, anal HPV16 prevalence increased from 1% in 3,118 cervical HR-HPV-negative to 10% in 848 h-HPV-positive women (PR=7.4,5.1–10.5), and from 2% in 3,998 cervical HPV16-negative to 30% in 273 cervical HPV16-positive women (PR=14.8,11.2–19.7). Among HIV-positive women, anal HPV16 increased from 7% in 451 cervical HR-HPV-negative to 19% in 408 cervical HR-HPV-positive women (PR=2.8,1.9–4.2), and from 9% in 750 cervical HPV16-negative to 38% in 109 cervical HPV16-positive women (PR=4.3,3.1–6.0). Anal HPV16 also increased with severity of cervical cytopathology, but the association was not significant after adjustment for cervical HPV status, irrespective of HIV status. In all strata of cervical outcomes, anal HPV16 infection was higher in HIV-positive than HIV-negative women, most often significantly so. Conclusions Cervical abnormalities predict anal HPV16 prevalence, but do not offer additional discriminatory power over cervical HPV status. Cervical HPV16-positive women, whether HIV-positive (38%) or HIV-negative (30%), show similar anal HPV16 prevalence as meta-analyses of HIV-positive MSM (~35%), the population with highest known anal cancer risk.