Women living with HIV (WLHIV) are at increased risk for human papillomavirus (HPV)-associated anal cancer. Given the “field effect” of HPV pathogenesis, some recommend that anal cancer screening should be limited to WLHIV with prior genital disease. This study aimed to characterize the relationship between anal and genital disease in WLHIV in order to better inform anal cancer screening guidelines. We retrospectively studied 153 WLHIV with biopsy-proven anal high-grade squamous intraepithelial lesions (AHSIL) and long-term evaluable cervical/vaginal/vulvar histopathology. Based on the absence or presence of genital HSIL, subjects were categorized as having isolated AHSIL or multicentric HSIL. Demographics, HIV parameters and cervical/anal HPV status were recorded. Chi-square test was used for bivariate analyses. Of 153 WLHIV with AHSIL, 110 (72%) had isolated AHSIL, while 43 (28%) had multicentric HSIL (28 cervical, 16 vulvar, and 8 vaginal HSIL). The median genital surveillance was 8 years (range 1–27). Cervical HPV16/18 infection was associated with multicentric disease (P = 0.001). Overall, 53% of multicentric cases presented genital HSIL preceding AHSIL with median interval 13 years (range 2–23). Paired anal and cervical high-risk HPV results were available for 60 women within 12 months of AHSIL diagnosis: 30 (50%) had anal infection alone, while 30 (50%) had anal/cervical coinfection by 16/18 (15%), non-16/18 (13%), or different types (22%). In conclusion, WLHIV frequently develop AHSILs without pre-existing genital disease or after long latency following a genital HSIL diagnosis. Our findings support anal cancer screening for WLHIV irrespective of prior genital disease.

感染 HIV (WLHIV) 的女性患人乳头瘤病毒 (HPV) 相关肛门癌的风险增加。鉴于 HPV 发病机制的“场效应”，一些人建议肛门癌筛查应仅限于具有既往生殖器疾病的 WLHIV。本研究旨在描述 WLHIV 中肛门和生殖器疾病之间的关系，以便更好地为肛门癌筛查指南提供信息。我们回顾性研究了 153 例经活检证实的肛门高度鳞状上皮内病变 (AHSIL) 和长期可评估的宫颈/阴道/外阴组织病理学的 WLHIV。根据生殖器 HSIL 的存在或不存在，受试者被分类为具有孤立的 AHSIL或多中心 HSIL. 记录了人口统计学、HIV 参数和宫颈/肛门 HPV 状态。卡方检验用于双变量分析。在 153 名患有 AHSIL 的 WLHIV 中，110 名 (72%) 患有孤立性 AHSIL，而 43 名 (28%) 患有多中心 HSIL（28 名宫颈、16 名外阴和 8 名阴道 HSIL）。生殖器监测的中位时间为 8 年（范围 1-27）。宫颈 HPV16/18 感染与多中心疾病相关（P = 0.001）。总体而言，53% 的多中心病例在 AHSIL 之前出现生殖器 HSIL，中位间隔为 13 年（范围 2-23）。在 AHSIL 诊断后 12 个月内，60 名女性获得了配对的肛门和宫颈高危 HPV 结果：30 名 (50%) 仅患有肛门感染，而 30 名 (50%) 患有肛门/宫颈合并感染，分别为 16/18 (15%) 、非 16/18 (13%) 或不同类型 (22%)。总之，WLHIV 在没有预先存在的生殖器疾病或在生殖器 HSIL 诊断后长时间潜伏期后经常发展为 AHSIL。我们的研究结果支持对 WLHIV 进行肛门癌筛查，而不管之前是否患有生殖器疾病。