Prevalence of anal high-risk human papillomavirus infection, cytologic and histologic abnormalities among Rwandan women living with human immunodeficiency virus

Abstract

This cross-sectional pilot study assessed 51 Rwandan women living with HIV (WLWH) with cervical high-risk human papillomavirus (hrHPV; n = 25) but < CIN2 or high-grade squamous intraepithelial lesions (HSIL) (CIN2+), due to higher anal hrHPV risk. Anal swabs underwent hrHPV genotyping and cytology. High-resolution anoscopy-guided biopsy was performed on clinically visible lesions. Mean age was 43.8 years. Anal hrHPV prevalence was 35.3% (95% confidence interval: 22.4–49.9). Cytology was negative (34/51 = 66.7%), unsatisfactory (10/51 = 19.6%), atypical squamous cells of undetermined significance (4/51 = 7.8%), low-grade squamous intraepithelial lesions (2/51 = 3.9%), and atypical squamous cells, cannot exclude HSIL (1/51 = 2.0%). Histology showed low-grade SIL in 21.6% and HSIL in 2.0%. Anal cytologic abnormalities were associated with hrHPV (p = 0.032); no cervical–anal concordance was observed. Findings support further research into anal cancer prevention among high-risk WLWH. What this study adds: Given the paucity of data on anal hrHPV in Rwanda, this study provides the first data about anal hrHPV, cytologic abnormalities and HSIL among WLWH. These preliminary findings will inform further research and may support future exploration of integrating anal cancer screening research within well-established cervical cancer screening platforms, pending larger confirmatory studies.