Among HIV-positive women, some studies put the incidence of anal cancer at seven to 28 times greater than the general population. Though the incidence of anal cancer has not been nearly as well studied in HIV-positive women compared with HIV-positive MSM, the confirmed higher rates of precancerous lesions—which can occur among women living with HIV, even if they’ve never engaged in anal sexual intercourse—remain a concern.
Yet there is no consensus between national and local groups on anal cancer screening among people living with HIV, either male or female. “Since 2007,” Hou and her colleague explain, “the New York State Department of Health (NYS DOH) has recommended annual anal cytology”—Dacron swabs analyzed by a laboratory—“in HIV-infected subjects with a history of [anal warts] or with abnormal cervical/vulvar histology, along with referral for high resolution anoscopy (HRA) in those with abnormal anal cytology or abnormal findings on anal exam. In contrast, the Department of Health and Human Services guidelines discourage screening and treatment programs for [anal intraepithelial neoplasia, or AIN] due to a lack of complete understanding of the relative harms and benefits of anal cytology screening.”
In turn, to better understand the incidence of precancerous anal lesions and the value of routine anal cytology, Hou and her colleagues conducted a study among women in the Bronx, which has one of the highest HIV prevalence rates in the country, representing 3 percent of the total U.S. HIV burden.