Screening anal cancer in women living with HIV/AIDS

The current study is an integrative literature review applied to articles published between 2013 and 2017 in databases such as PUBMED, EBSCO and LILACS.

Results:

Eight studies were selected to compose the current review after the inclusion and exclusion criteria were applied. All the articles had evidence level IV. Anal cytology and the DNA-HPV test were the methodologies prevailing in the studies. The number of participants in the studies ranged from 35 to 863, and all the studies involved women living with HIV/AIDS. The aim of most of the herein reviewed studies was to assess the prevalence of anal cytologic changes or HPV infection in women living with HIV/AIDS (WLHA).

Conclusion:

Studies have pointed out that there is concern about high anal cancer and anal HPV infection rates. They also highlighted the importance of the screening procedure for anal cancer prevention through cytology associated, or not, with molecular HPV detection methods.

Keywords
HIV; HPV; Anal cancer

Article	Author Place Year	Study type/evidence level	Sample size/recruitment period	Methodology
A1	Gaisa et al. USA 2016	Retrospective cohort study IV	745 WLHA 2009 to 2014	Conventional cytology (anal) Anoscopy
A2	Goeieman et al. South Africa 2017	Cross-sectional study IV	200 WLHA^a a The period when the study was conducted was not described.	Conventional cytology (anal and cervical) Anoscopy DNA-HPV test: Digene Hybrid Capture 2 and Aptima E6/E7 mRNa to detect HPV
A3	Hessol et al. USA 2013	Nested cohort cross-sectional study IV	470 WLHA^b b The study also included women without HIV, whose results were not included because they were not relevant to the aim of the integrative review. 2001 to 2003	Liquid-based cytology (anal) Conventional cytology (cervical) Colposcopy and Anoscopy DNA-HPV test: PCR and hybridization typing
A4	Pittyanont et al. Thailand 2014	Prospective descriptive study IV	590 WLHA 2013 to 2014	Conventional cytology (anal) DNA-HPV test: Cervista human papillomavirus high risk (HPV HR) assays and Cervista HPV 16/18 assays
A5	Sananpanichkul et al. Thailand 2015	Prospective descriptive study IV	599 WLHA 2013 to 2014	Conventional cytology (anal and cervical)
A6	Bisherwal et al. India 2016	Cross-sectional study IV	40 WLHA^a a The period when the study was conducted was not described. 2011 to 2013	Conventional cytology (anal and cervical)
A7	Cambou et al. Brazil 2015	Cohort study IV	863 WLHA 2011 to 2013	Liquid-based cytology (anal and cervical) Anal DNA-HPV test: PapilloCheck HPV-Screening Test Cervical DNA-HPV test: Linear-Array HPV Genotyping Test
A8	Heard et al. France 2015	Nested cohort cross-sectional study IV	171 WLHA 2012	Liquid-based cytology (anal and cervical) Anoscopy DNA-HPV test: Linear-Array HPV Genotyping Test

Article	Anal cytology	Anal HPV	Anoscopy/biopsy	Cervical cytology
A1	292 (39%) changes in baseline cytology 111 (15%) changes in follow-up cytology	^a a The study did not include tests for this methodology.	208 (71.2%) performed anoscopy 147 (50%) in baseline cytology and 61 (55%) in follow-up cytology 138 (94%) of baseline cytology showed changes in biopsy 44 (72%) of follow-up cytology showed changes in biopsy HSIL: 38 (26%) in baseline cytology and 11 (18%) in follow-up cytology Anal dysplasia of any degree: 100 (68%) in baseline cytology 33 (54%) in follow-up cytology 1 (0.7%) Anal carcinoma	^a a The study did not include tests for this methodology.
A2	148 (74.5%) with changes in cytology 32 (16%) ASC-US 97 (49%) LSIL 19 (9.5%) ASC-H/HSIL	High-risk HPV in 43%	148 performed anoscopy 89 (60.1%) performed biopsy: 72 (48%) LSIL 17 (8.5%) HSIL	138 (70%) with changes in cytology 11 (6%) ASC-US 98 (49%) LSIL 29 (15%) HSIL or ASC-H
A3	120 (25%) with changes in cytology 40 (8.5%) ASC 50 (10.6%) LSIL 30 (6.4%) HSIL	163 (42%) infected with anal and cervical HPV	394 (83.8%) subjected to cytology/anoscopy/biopsy^b b The results were not separately presented in the article. Note: In this study, data on sensitivity and specificity of anal cytology were also described, corresponding to 12% and 91.4%, respectively.	134 (28.5%) with changes in cytology 48 (10.2%) ASC 63 (13.4%) LSIL 23 (4.9%) HSIL
A4	13 (2.2%) with changes in cytology 11 (1.9%) ASC-US 2 (0.3%) HSIL	88.9% presented high-risk HPV (8 out of 9 tested samples)	^a a The study did not include tests for this methodology.	^a a The study did not include tests for this methodology.
A5^a a The study did not include tests for this methodology.	14 (2.3%) with changes in cytology 3 (0.5%) HSIL 11 (1.8%) LSIL or less	^a a The study did not include tests for this methodology.	^a a The study did not include tests for this methodology.	116 (19.4%) with changes in cytology 46 (7.6%) HSIL 70 (11.6%) LSIL or lower atypia degree WLHA with abnormal cervical cytology showed 3.8 times higher risk of abnormal anal cytology
A6	3 (7.5%) with changes in cytology 0 (0%) ASC-US 2 (5%) LSIL 1 (2.5%) HSIL	^a a The study did not include tests for this methodology.	^a a The study did not include tests for this methodology.	10 (25%) with changes in cytology 2 (5%) ASC-US 6 (20%) LSIL 2 (5%) HSIL 29.4% presented concomitant cervical and anal dysplasia
A7	267 (31%) with changes in cytology 124 (14%) ASC-US 97 (11%) LSIL 13 (2%) ASC-H 33 (4%) HSIL or more	51% had at least one high-risk HPV type	^a a The study did not include tests for this methodology.	174 (20%) with changes in cytology 72 (8.4%) ASC-US 86 (10.0%) LSIL 2 (0.2%) ASC-H 14 (1.6%) HSIL AGC 5 (0.6%) WLHA with cervical LSIL cervical are more likely to present abnormal anal cytology
A8	44 (29.3%) with changes in cytology ASC-US/LSIL in 28 (18.7%) ASC-H/HSIL 15 (10.0%) Anal carcinoma 1 (0.6%)	99 (57.9%) presented high-risk HPV 81 (47.4%) presented multiple infections 29 (17%) presented HPV 16 infection	169 (98.8%) performed anoscopy and 69 (34.5%) of them performed biopsy 18 (28.1%) LSIL 10 (15.6%) HSIL 1 (1.6%) anal carcinoma	28 (18%) with changes in cytology 26 (15.3%) ASC-US/LSIL 2 (1.1%) ASC-H/HSIL WLHA with cervical LSIL cervical are more likely to present abnormal anal cytology

Sociedade Brasileira de Coloproctologia Av. Marechal Câmara, 160/916, 20020-080 Rio de Janeiro/RJ Brasil, Tel.: (55 21) 2240-8927, Fax: (55 21) 2220-5803 - Rio de Janeiro - RJ - Brazil
E-mail: sbcp@sbcp.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author. E-mail: vanessa.diefenthaler@yahoo.com.br (V.L. Diefenthäler).