Two-years persistence of anal high-risk HPV infections in women living with HIV, results from the EVVA study

Background: Women living with HIV are at increased risk of anal high-grade squamous intraepithelial lesions (HSIL) and anal cancer because of higher persistence of high-risk HPV (HR-HPV) infection. This study describes the persistence of type-specific anal HR-HPV over two years. Methods: EVVA (Evaluation of HPV, HIV, and AIN in women) is a cohort study of 151 adult women living with HIV in Montreal (Canada), with biannual cervical/anal HPV testing and cytology for 2 years and at two systematic high-resolution anoscopies for all participants. Only participants who completed 2 study visits were included in this analysis (n=135). Results: Persistent anal infection by at least one HR-HPV was observed in 40.7% of participants (55/135, 95% confidence interval (CI) 32.4–49.5), persisting for 2 years in majority. Persistent HPV-16 was observed in 10.4% (14/135, 95%CI 5.8–16.8), detected for 2 years in 13 women. HPV-18 persisted in 6.7% (95%CI 3.1–12.3), HPV-45 in 11.1% (95%CI 6.4–17.7), HPV-51 in 11.9% (95%CI 6.9–18.5), HPV-52 in 8.9% (95%CI 4.7–15.0) and HPV-58 in 7.4% (95%CI 3.6–13.2). Anal histological HSIL was detected in 50.9% (28/55, 95%CI 37.1–64.6) of women with persistent HR-HPV infection by at least one type, and in 15.0% (12/80, 95%CI 8.0–24.7) of women who never had. Conclusions: Our study confirms that persistence of anal HR-HPV is common in women living with HIV, most of the persistent infections being identified for at least 2 years. Anal HSIL is detected more frequently in women with persistent anal HR-HPV