Treatment Issues for Women
Anal HPV and Anal Dysplasia
Anal HPV is common in women with HIV, especially women who've had genital warts, anal sex, or cervical dysplasia. One large study (called the Women's Interagency HIV Study) found anal HPV in 70% of positive women studied. When these women had anal Pap smears, abnormal cells were found in 42% of the women with CD4 counts less than 200, and 25% of the women with CD4 counts between 200 and 500. Although anal sex is the most direct way to get anal HPV, you can have anal HPV even if you've never had anal sex.
If you have HPV, ever had cervical dysplasia, or you've had anal sex, ask your doctor for a butt exam and an anal Pap smear to check for anal HPV. Anal Paps are like cervical Paps -- they collect cells to screen for lesions in the anus. If ASCUS, ASC-H, or any other abnormalities are found, your doctor can use an anoscope (similar to a colposcope) to look inside your anal canal and identify any lesions, warts, or abnormal tissue that might need treatment.
Routine cervical screening, followed by treatment of high-grade dysplasia, has dramatically cut the rate of cervical cancer in women. Despite possibly high rates of anal dysplasia in HIV, no comparable screening guidelines exist for anal abnormalities. An anal screening and treatment program, similar to cervical screening, could help prevent anal cancer in both women and men with HIV.
As positive women, it's important that we keep being evaluated regularly for cervical HPV, and for anal HPV. Many providers have no experience with anal Pap smears. If our healthcare providers are unskilled at performing anal Pap smears, we need to encourage them to attend trainings and become proficient with anal screening. If they refuse, we should insist on being seen by providers who can perform these necessary evaluations. When we show sufficient demand, important medical procedures like anal screening can become routine components of our HIV care.