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

Chunqing Lin, Jiri Slama, Paula Gonzalez, Marc T. Goodman, Ningshao Xia, Aimée R. Kreimer, Ting Wu, Nancy A. Hessol, Yurii Shvetsov, Ana P. Ortiz, Beatriz Grinsztejn, Anna Barbara Moscicki, Isabelle Heard, María del Refugio González Losa, Erna M. Kojic, Maarten F. Schim van der Loeff, Feixue Wei, Adhemar Longatto-Filho, Zizipho A. Mbulawa, Joel M. PalefskyAnnette H. Sohn, Brenda Y. Hernandez, Katina Robison, Steve Simpson, Lois J. Conley, Alexandra de Pokomandy, Marianne A.B. van der Sande, Racheal S. Dube Mandishora, Lays P.B. Volpini, Alessandra Pierangeli, Byron Romero, Timothy Wilkin, Silvia Franceschi, Carmen Hidalgo-Tenorio, Reshmie A. Ramautarsing, Ina U. Park, Fernanda K. Tso, Sheela Godbole, Kathleen W.M. D'Hauwers, Borek Sehnal, Lynette J. Menezes, Sandra A. Heráclio, Gary M. Clifford

Research output: Contribution to journalArticlepeer-review


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 16·5, 95% CI 14·2–19·2, p<0·0001); these values were 46% (125/273) versus 11% (272/2588) in HIV-positive women (4·4, 3·7–5·3, p<0·0001). 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 14·1, 11·1–17·9, p<0·0001). 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 12·9, 95% CI 6·7–24·8, p<0·0001) and HIV-positive women (from 8% [84/1094] to 17% [31/186]; 2·3, 1·6–3·4, p<0·0001). 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 23·1, 9·4–57·0, p<0·0001) and HIV-positive women (from 7% [105/1421] to 25% [25/101]; 3·6, 2·5–5·3, p<0·0001). 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. Funding: International Agency for Research on Cancer.

Original languageEnglish
Pages (from-to)880-891
Number of pages12
JournalThe Lancet Infectious Diseases
Issue number8
Publication statusPublished - Aug 2019

ASJC Scopus subject areas

  • Infectious Diseases

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