Journal of Medical Virology 84:1335–1339 (2012) Prevalence of Abnormal Anal Cytology in Women Infected With HIV Eunice Beatriz Martin Chaves, 1,2 Heloı ´sa Folgierini, 3 Edison Capp, 1,2 * and Helena von Eye Corleta 1,2 1 Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil 2 Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Laboratory of Molecular Obstetrics and Gynecology, Hospital de Clı´nicas de Porto Alegre, Porto Alegre, Brazil 3 Department of Pathology, Hospital de Clı´nicas de Porto Alegre, Porto Alegre, Brazil Anal cancer is a rare disease. Nevertheless, it may be a reason for concern among groups in which its incidence is increasing: those who en- gage in anoreceptive intercourse, promiscuous persons, and those with sexually transmitted infections (HPV and HIV). The aim of this study was to evaluate the prevalence of abnormal anal cytology in women infected with HIV seen at Hospital de Clı ´nicas de Porto Alegre, Brazil. A cross-sectional design was used. Anal smear screening was offered to all women infected with HIV seen at the hospital’s outpatient sexually transmitted infections clinic from March 2006 to March 2008. A total of 184 patients were thus enrolled. Only patients who gave written consent were included in the study. The prevalence of abnormal anal cytology was 14.1% (26 patients). Twenty-two patients presented atypical squamous cells of undetermined significance, and four exhibited low-grade intraepithelial neoplasia. Initially, abnormal anal cytology was significantly associated with age, number of pregnancies, smoking, abnormal cervical cytology, CD4 þ < 200 cells/mm 3 and hepatitis C co-infection. After adjustment, only CD4 þ < 200 cells/mm 3 and smoking were found to increase the risk of altered anal cytology. The anal Pap method described is simple and can be used for screen- ing in cohorts of HIV-positive women who are at risk of developing anal carcinoma, mainly those with CD4 þ counts <200 cells/mm 3 and smokers. J. Med. Virol. 84:1335–1339, 2012. ß 2012 Wiley Periodicals, Inc. KEY WORDS: anal cytology; women infected with HIV; intraepithelial neoplasia; risk factors INTRODUCTION The incidence of anal cancer remained fairly con- stant in the period from 1943 to 1957 and was similar for men and women. Thereafter, it increased 1.5-fold among men and tripled among women [Frisch et al., 1993]. Until recently, anal malignancy was not consid- ered to be of public health concern. Nevertheless, anal squamous intraepithelial lesions have become a rea- son for concern in groups in which their incidence is increasing: women who engage in anal intercourse and those with anal HPV infection, HIV viral load and abnormal cervical cytology [Holly et al., 2001; Instituto Nacional do Ca ˆ ncer. Ministe ´rio da Sau ´ de, 2006]. Men who have sex with men (MSM) and men infected with HIV also have higher rates of anal can- cers [Daling et al., 1987]. As with cervical cancer, epidemiologic studies have indicated that anal cancer has a prolonged preclinical phase, even in high-risk groups [Leiman, 2005]. However, many patients are diagnosed late, when symptoms or lesions are evident and the disease is at an advanced stage. Another issue that hinders diagnosis is that lesions which arise near the anus sometimes are considered to be HPV-related skin lesions rather than a sign of anal malignancy. Relatively little is known about the epidemiology of anal lesions among women infected with HIV and its Grant sponsor: Fundo de Incentivo a ` Pesquisa (FIPE) do Grupo de Pesquisa e Po ´s-Graduac ¸a ˜o (GPPG) do Hospital de Clı ´nicas de Porto Alegre. *Correspondence to: Prof. Edison Capp, Servic ¸o de Ginecolo- gia e Obstetrı ´cia—Hospital de Clı ´nicas de Porto Alegre, Rua Ramiro Barcelos, 2350/118 andar—Porto Alegre, RS 90035-903, Brazil. E-mail: edcapp@ufrgs.br Accepted 10 May 2012 DOI 10.1002/jmv.23346 Published online in Wiley Online Library (wileyonlinelibrary.com). ß 2012 WILEY PERIODICALS, INC.