Thursday, April 5, 2012

Researchers Stress the Importance of Screening Women for Precancerous Anal Lesions

via AIDSmeds, by Tim Horn

Results from a study conducted in the Bronx, New York, serve as an important reminder to HIV care providers: Comprehensive screening for precancerous anal lesions isn’t of importance only to HIV-positive men who have sex with men (MSM). According to the Journal of Acquired Immune Deficiency Syndromes report by researchers at Albert Einstein College of Medicine in the Bronx, precancerous lesions are also common among women living with HIV—and testing for them using anal swabs alone may not be sufficient to rule out problems requiring biopsies.

Numerous studies have noted high rates of anal cancer among MSM. According to one study cited by June Hou, MD, and her colleagues at Albert Einstein, the incidence of anal cancer among MSM is 10 to 50 times that of the general population and comparable to cervical cancer incidence rates before the implementation of now-routine screening practices.

Among HIV-positive women, some studies put the incidence of anal cancer at seven to 28 times greater than the general population. Though the incidence of anal cancer has not been nearly as well studied in HIV-positive women compared with HIV-positive MSM, the confirmed higher rates of precancerous lesions—which can occur among women living with HIV, even if they’ve never engaged in anal sexual intercourse—remain a concern.

Yet there is no consensus between national and local groups on anal cancer screening among people living with HIV, either male or female. “Since 2007,” Hou and her colleague explain, “the New York State Department of Health (NYS DOH) has recommended annual anal cytology”—Dacron swabs analyzed by a laboratory—“in HIV-infected subjects with a history of [anal warts] or with abnormal cervical/vulvar histology, along with referral for high resolution anoscopy (HRA) in those with abnormal anal cytology or abnormal findings on anal exam. In contrast, the Department of Health and Human Services guidelines discourage screening and treatment programs for [anal intraepithelial neoplasia, or AIN] due to a lack of complete understanding of the relative harms and benefits of anal cytology screening.”

In turn, to better understand the incidence of precancerous anal lesions and the value of routine anal cytology, Hou and her colleagues conducted a study among women in the Bronx, which has one of the highest HIV prevalence rates in the country, representing 3 percent of the total U.S. HIV burden.

Read the Rest.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

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