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Cervical determinants of anal HPV infection and high-grade anal lesions in women: a collaborative pooled analysis


Lin, C and Slama, J and Gonzalez, P and Goodman, MT and Xia, N and Kreimer, AR and Wu, T and Hessol, NA and Shvetsov, Y and Ortiz, AP and Grinsztejn, B and Moscicki, AB and Heard, I and Del Refugio Gonzalez Losa, M and Kojic, EM and Schim van der Loeff, MF and Wei, F and Longatto-Filho, A and Mbulawa, ZA and Palefsky, JM and Sohn, AH and Hernandez, BY and Robison, K and Simpson Jr, S and Conley, LJ and de Pokomandy, A and van der Sande, MAB and Dube Mandishora, RS and Volpini, LPB and Pierangeli, A and Romero, B and Wilkin, T and Franceschi, S and Hidalgo-Tenorio, C and Ramautarsing, RA and Park, IU and Tso, FK and Godbole, S and D'Hauwers, KWM and Sehnal, B and Menezes, LJ and Heraclio, SA and Clifford, GM, Cervical determinants of anal HPV infection and high-grade anal lesions in women: a collaborative pooled analysis, Lancet Infectious Diseases, 19, (8) pp. 880-891. ISSN 1473-3099 (2019) [Refereed Article]


Copyright Statement

Copyright 2019 International Agency for Research on Cancer. Licensed under Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO (CC BY-NC-ND 3.0 IGO)

DOI: doi:10.1016/S1473-3099(19)30164-1


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 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 165, 95% CI 142-192, p<00001); these values were 46% (125/273) versus 11% (272/2588) in HIV-positive women (44, 37-53, p<00001). 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 141, 111-179, p<00001). 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 129, 95% CI 67-248, p<00001) and HIV-positive women (from 8% [84/1094] to 17% [31/186]; 23, 16-34, p<00001). 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 231, 94-570, p<00001) and HIV-positive women (from 7% [105/1421] to 25% [25/101]; 36, 25-53, p<00001). 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.

Item Details

Item Type:Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Infectious diseases
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Simpson Jr, S (Dr Steve Simpson JR)
ID Code:133607
Year Published:2019
Web of Science® Times Cited:55
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-07-03
Last Modified:2020-08-12
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