A study by Montefiore Medical Center has found high rates of anal cancer among women infected with HIV.
The study entitled, "High Prevalence of High Grade Anal
Intraepithelial Neoplasia in HIV-Infected Women Screened for Anal Cancer," to
be published in the Journal of Aids on May 1.
"Anal cancer was widely associated with HIV-infected men who
have sex with men," said Mark H. Einstein, MD, MS, Director of Clinical
Research, Division of Gynecologic Oncology at Montefiore Medical
Center and Professor at
Albert Einstein College of Medicine. "But now, this study reveals anal
precancerous disease in a high proportion of women with HIV."
Out of 715 asymptomatic HIV-infected women studied, 10.5%
exhibited some form of anal disease and approximately one third of them were
found to be true pre-cancerous disease. The researchers determined that this is
likely due to the fact that HIV promotes human papillomavirus (HPV) persistence
and consequently, which is known to cause nearly all anal cancers. HIV-infected
individuals are also at increased risk for the development of many other
The incidence of anal carcinoma (AC) has been increasing
despite the implementation of antiretroviral therapy (ART), which has not been
shown to consistently alter the course of HPV-associated anogenital disease.
The women studied were Montefiore patients in the Bronx,
which has one of the highest HIV prevalence rates in the United States.
Data indicates that 1.8% of the Bronx
population is known to be HIV infected, representing 3% of the total number of
HIV patients in the entire country. Montefiore is the largest provider of
medical services for people with HIV in the Bronx
and has adopted routine screening for AC with annual anal cytology in all
As a result of these findings, Dr. Einstein and his
colleagues recommend that all HIV+ women who have any abnormal anal cytology be
referred for high resolution anoscopy, particularly those with poorly
controlled HIV who are significantly at even higher risk for harboring a
high-grade AIN than women who are well controlled. Also, all HIV infected men
and women should be considered for anal cancer screening. Given the lower
high-grade anal disease prevalence in women with well-controlled HIV, other
strategies to improve disease ascertainment, such as inclusion of HPV testing
might be found to be useful for AC screening. This risk stratification might
prove to be different for women than it is for men, where prevalence rates seem
to be considerably higher. Given the high rate of high-grade anal precancerous
lesions in screened HIV-infected women and an aging population of HIV-infected
patients, measures to increase routine AC screening should be strongly
considered. Depending on the size of the pre-cancerous legion, it can be
removed long before it becomes cancer, thus being able to save lives.
The study was conducted from March 2008 to December 2010.
Dr. Einstein's primary research interests focus on the
pathogenesis and therapy for cervical cancer. He has developed and has been
leading numerous multi-institutional clinical trials in targeting HPV and
cervical cancer as well as cervical cancer prevention. He is active in clinical
trial cooperative groups as Co-Chair of the Gynecologic Oncology Group Vaccine
Committee and sits on the GOG Cervix Committee. He is on the HPV working group
of the NCI Aids Malignancy Consortium. Dr. Einstein is also a program leader of
the Gynecology Division of the New York Cancer Consortium and is the primary
investigator of many of its gynecologic cancer therapeutics trials accruing
patients throughout New York
hospitals. He is active in policy-making regarding cervical cancer prevention,
participating in the development of the American Cancer Society recommendations
for HPV vaccines as well as the working group for the Society of Gynecologic
Oncology's (SGO) HPV vaccine recommendations. He is Chair of the Gynecologic
Oncology Foundation's (GCF) National Cervical Cancer Public Education Campaign
and sits on their Board of Directors.