Quality of life in women with HPV and accurary of direct visual anal inspection with acetic acid and lugol compared to high-resolution anoscopy to diagnose intraepithelial anal lesion

Geyson Alves Marinho,Anna Christina Cabral Cordeiro Da Silva,Sandra De Andrade Heraclio,Djalma Agripino De Melo Filho,Matheus Gomes De Oliveira,Raquel Kelner Silveira

doi:10.1590/1806-93042021000100014

Abstract

Abstract Objectives: to describe life quality of women with HPV and analyze the accuracy of anal visual inspection with acetic acid and lugol compared to high-resolution anoscopy in the detection of anal intraepithelial lesions. Methods: diagnostic evaluation study conducted with adult solid-organ transplant recipients and/or diagnosed with HIV and/or with a history of anogenital neoplasia, attended at the High Resolution Anoscopy outpatient clinic between April and December 2018. To calculate the accuracy parameters, 87 women participated: 44 with lesions and 43 without them. The 44 women with lesions were also subjected to a descriptive study to assess their life quality using the SF-36 questionnaire. Results: it was observed that almost half of the women in the study practiced vaginal, anal and oral intercourse without condom. History of HPV infection and anogenital neoplasia were the most prevailing with percentages of 81% and 72.7%, respectively. In five out of the eight domains of SF-36 they did not perform well in regard to life quality. Visual inspection with acetic acid and lugol presented sensitivity of 22.7% and specificity of 100%. Conclusion: unsatisfactory life quality was evidenced. Direct visual inspection with acetic acid and lugol should not be used in trials to spot intraepithelial HPV lesions, for it presents low sensitivity.

Highlights

The human papilloma virus (HPV) is the most frequent infectious agent of the world.[1,2] In 2012, approximately 4.5% (640,000) new cancer cases were attributed to HPV infection.[3]
Anal cancer is preceded by a high-grade intraepithelial anal neoplasia, a pre-malignant lesion caused by the presence of HPV, which can evolve into squamous cell carcinoma of the anal canal
There are few studies which evaluate the impact of lesions caused by anal HPV in women’s quality of life.12,13Taking into consideration the cirumstances, the goal of this paper is to analyze the accuracy of visual inspection with acetic acid (VIA)/VILI compared to high-resolution anoscopy (HRA) to detect intraepithelial anal neoplasia (IAN) and describe the profile and quality of life of women with anal HPV

Summary

Introduction

The human papilloma virus (HPV) is the most frequent infectious agent of the world.[1,2] In 2012, approximately 4.5% (640,000) new cancer cases were attributed to HPV infection.[3] Anal cancer is strongly associated with HPV infection.[4] Within the general public, anal cancer is relatively uncommon, representing 3% of all gastrointestinal tract cancers. The cases are increasing globally having almost doubled in the last 25 years.[5]. The behaviour of the mentioned lesions, as well as the most appropriate methods of tracking and observing them, remain controversial.[6] Most strategies utilized nowadays to prevent and treat anal lesions related to HPV are based on the understanding of how HPV infections in the cervix work and on the evolution of intraepithelial lesions and cervical cancer.[7]

Objectives

Methods

Results

Conclusion