A cross-sectional pilot study to define anal cancer risk factors in HIV-positive solid organ transplant recipients

HIV-positive organ transplant recipients are at high risk of anal cancer, but there are no data on the prevalence of high-risk human papillomavirus (hr-HPV) or anal dysplasia, in this population.

To assess the prevalence of anal hr-HPV, and anal cytological and histological abnormalities in this population.

Prospective single tertiary hospital.

Twenty-five (53%) transplant recipients were recruited from 47 eligible individuals. Median (IQR) age was 56 years (52.5-60), 17 were male, 9 (36%) were men who have sex with men and 8 (32%) were active smokers. Twelve (48%) patients had abnormal anal cytology and 12 (48%) had detectable hr-HPV DNA. Six (50%) individuals with abnormal cytology had high-grade squamous intraepithelial lesions (HSIL) on biopsy. Abnormal anal cytology was significantly associated with current hr-HPV infection [crude prevalence rate ratio, cRR = 2.3, 95% CI (1.43-3.7); p = 0.001] and any previous history of HPV associated disease [cRR = 2.49, 95% CI (1.09-5.67); p = 0.030]. Anal HSIL on biopsy was associated with presence of condyloma [cRR = 3.00, 95% CI (1.31-6.88); p = 0.001] and any previous history of any HPV associated disease [cRR = 6.67, 95% CI (0.96-46.32); p = 0.055]. Anal hr-HPV infection was associated with any previous HPV disease (Crude risk ratios [cRR = 2.89, 95% CI (1.21-6.88); p = 0.017]) and presence of condyloma (Crude risk ratios [cRR = 2.00, 95% CI (1.28-3.13); p = 0.002]). No cases of invasive anal cancer were detected among study participants.

This highly medicalized population of HIV-positive organ transplant recipients have a high prevalence of HPV-associated anal dysplasia and screening to prevent anal cancer may need to be prioritised.