Self-Screening HPV and Anal Dysplasia in HIV Infected Women

Yvonne Maldonado
Stanford University
Clinical Sciences

Human Papillomavirus (HPV) is the most common sexually transmitted infections (STIs) in adults worldwide and is a well known cause of anal cancer. Currently, there are no national screening guidelines for anal HPV testing or anal papanicolaou (PAP) screening for cancer. Persons living with HIV are at higher risk for acquiring HPV infections and HPV associated cancers. Although women comprise the majority of anal cancer cases in the United States, research regarding an acceptable means of screening at risk populations particularly human immunodeficiency virus (HIV) infected women are lacking. Much of the research regarding the detection of anal HPV has been performed in men who have sex with men (MSM). Self-collected specimens has been found to acceptable mean of screening women for STIs including HPV and may be a feasible means to reach women who would not have previously participated in screening programs.

We propose a study that looks at self-collected anal PAP specimens for the diagnosis of HPV infection and screening for early anal cancer in adult HIV infected women and women at risk for HIV and HPV acquisition. Self-collected specimens will be facilitated with the aid of an illustrated instruction sheet and acceptability of this procedure will be reviewed with a post PAP survey. Additionally, we will examine concurrent HPV types in the anus and cervix and the presence of associated cancer and pre cancer stages over a 9 month period in those individuals with an initial positive anal PAP. Basic HPV knowledge, social, and demographic variables in this population will also be reviewed in this high risk population.

We anticipate that self-collected samples will be an acceptable and reasonable screening process for HPV infection and early anal cancer screening in high risk and HIV infected women. Ultimately, the results of this study may allow for a large scale screening process in high risk women or those with limited use of and access to healthcare.