Cervical determinants of anal HPV infection and high-grade anal lesions in women: a collaborative pooled analysis
Lin, Chunqing; Slama, Jiri; Gonzalez, Paula; Goodman, Marc T; Xia, Ningshao; Kreimer, Aimée R; Wu, Ting; Hessol, Nancy A; Shvetsov, Yurii; Ortiz, Ana P; Grinsztejn, Beatriz; Moscicki, Anna-Barbara; Heard, Isabelle; Del Refugio González Losa, María; Kojic, Erna M; Schim van der Loeff, Maarten F; Wei, Feixue; Longatto-Filho, Adhemar; Mbulawa, Zizipho A; Palefsky, Joel M; Sohn, Annette H; Hernandez, Brenda Y; Robison, Katina; Simpson, Steve; Conley, Lois J; de Pokomandy, Alexandra; van der Sande, Marianne A B; Dube Mandishora, Racheal S; Volpini, Lays P B; Pierangeli, Alessandra; Romero, Byron; Wilkin, Timothy; Franceschi, Silvia; Hidalgo-Tenorio, Carmen; Ramautarsing, Reshmie A; Park, Ina U; Tso, Fernanda K; Godbole, Sheela; D'Hauwers, Kathleen W M; Sehnal, Borek; Menezes, Lynette J; Heráclio, Sandra A; Clifford, Gary M
(2019) The Lancet Infectious Diseases, volume 19, issue 8, pp. 880 - 891
(Article)
Abstract
Background: Cervical cancer screening might contribute to the prevention of anal cancer in women. We aimed to investigate if routine cervical cancer screening results—namely high-risk human papillomavirus (HPV) infection and cytohistopathology—predict anal HPV16 infection, anal high-grade squamous intraepithelial lesions (HSIL) and, hence, anal cancer. Methods: We did a systematic review
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of MEDLINE, Embase, and the Cochrane library for studies of cervical determinants of anal HPV and HSIL published up to Aug 31, 2018. We centrally reanalysed individual-level data from 13 427 women with paired cervical and anal samples from 36 studies. We compared anal high-risk HPV prevalence by HIV status, cervical high-risk HPV, cervical cytohistopathology, age, and their combinations, using prevalence ratios (PR) and 95% CIs. Among 3255 women with anal cytohistopathology results, PRs were similarly calculated for all anal HSIL and HPV16-positive anal HSIL. Findings: Cervical and anal HPV infections were highly correlated. In HIV-negative women, anal HPV16 prevalence was 41% (447/1097) in cervical HPV16-positive versus 2% (214/8663) in cervical HPV16-negative women (PR 16·5, 95% CI 14·2–19·2, p<0·0001); these values were 46% (125/273) versus 11% (272/2588) in HIV-positive women (4·4, 3·7–5·3, p<0·0001). Anal HPV16 was also associated with cervical cytohistopathology, with a prevalence of 44% [101/228] for cervical cancer in HIV-negative women (PR vs normal cytology 14·1, 11·1–17·9, p<0·0001). Anal HSIL was associated with cervical high-risk HPV, both in HIV-negative women (from 2% [11/527] in cervical high-risk HPV-negative women up to 24% [33/138] in cervical HPV16-positive women; PR 12·9, 95% CI 6·7–24·8, p<0·0001) and HIV-positive women (from 8% [84/1094] to 17% [31/186]; 2·3, 1·6–3·4, p<0·0001). Anal HSIL was also associated with cervical cytohistopathology, both in HIV-negative women (from 1% [5/498] in normal cytology up to 22% [59/273] in cervical HSIL; PR 23·1, 9·4–57·0, p<0·0001) and HIV-positive women (from 7% [105/1421] to 25% [25/101]; 3·6, 2·5–5·3, p<0·0001). Prevalence of HPV16-positive anal HSIL was 23–25% in cervical HPV16-positive women older than 45 years (5/20 in HIV-negative women, 12/52 in HIV-positive women). Interpretation: HPV-based cervical cancer screening programmes might help to stratify anal cancer risk, irrespective of HIV status. For targeted secondary anal cancer prevention in high-risk groups, HIV-negative women with cervical HPV16, especially those older than 45 years, have a similar anal cancer risk profile to that of HIV-positive women. Funding: International Agency for Research on Cancer.
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Keywords: Infectious Diseases, Journal Article
ISSN: 1473-3099
Publisher: Lancet Publishing Group
Note: Funding Information: AHS reports grants from US National Institutes of Health (NIH), during the conduct of the study, and grants and travel expenses from ViiV Healthcare, outside the submitted work. NAH reports grants from the US National Cancer Institute and NIH, during the conduct of the study. RAR reports grants from National Research University, Thailand and the Ratchadaphiseksomphot Endowment Fund, during the conduct of the study. JMP reports grants and personal fees from Antiva Biosciences; personal fees from Agenovir, Novan, Janssen Pharmaceuticals, and Vaccitech; grants and non-financial support from Merck; non-financial support from Hologic; and stock options from Virion Therapeutics and Ubiome, outside the submitted work. MFSvdL reports grants from Sanofi Pasteur, MSD, and Janssen Infectious Diseases and Vaccines; support for an investigator-initiated study from Merck; and non-financial support from Stichting Pathologie Onderzoek en Ontwikkeling, outside the submitted work. TW reports grants and personal fees from GlaxoSmithKline and ViiV Healthcare and grants from Gilead, outside the submitted work. All other authors declare no competing interests. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned. Publisher Copyright: © 2019 International Agency for Research on Cancer
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