Grant: Operating Grant - PA: HIV/AIDS Bridge Funding - Health Services/Pop Hlth Stream

Despite treatment of HIV infection with antiretroviral medication, HIV-positive women are at increased risk of anal cancer compared to the general population. The main cause of anal cancer is infection by the Human Papillomavirus (HPV), the same virus responsible for cervical cancer. It is possible to detect precancerous lesions, called Anal Intraepithelial Neoplasia (AIN), before they become invasive cancer. Unfortunately most studies on HPV-related anal disease have been conducted in HIV-positive men. Very little is known about the natural evolution of anal HPV infection and AIN in HIV-positive women. We propose a cohort study of 150 HIV-positive women in Montreal. The general objective of our study is to describe the burden and short term natural history of anal HPV and AIN in HIV-positive women. The data collected will also allow the identification of risk factors associated with high grade AIN in these women and will serve to inform the need to build a larger country-wide study of anal HPV and AIN in HIV-positive women. Participating women will be aged 18 or older, living in Montreal, without a previous diagnosis of anal cancer. Visits will occur every 6 months for 2 years, and will include self-administered questionnaires, medical chart review, cervical cytology (PAP test), cervical HPV testing, anal cytology and anal HPV testing. A more precise examination of the anal canal through high resolution anoscopy (HRA) will be done twice in all women (at baseline and at 2 years) with biopsies, which is the test required to confirm the diagnosis of AIN. Additional HRA will be performed during the study as clinically indicated. Like cervical cancer, anal cancer is a potentially preventable cancer. This study is necessary to better understand HPV-related anal diseases in HIV-positive women and to guide clinical practice. The richness of the data collected may have a great impact on the health care of HIV-positive women and anal cancer prevention.