A Pilot Study of the Prevalence of Anal Human Papillomavirus and Dysplasia in a Cohort of Patients With IBD

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Abstract

BACKGROUND:

Defective cell-mediated immunity increases the risk of human papillomavirus–associated anal dysplasia and cancer. There is limited information on anal canal disease in patients with IBD.

OBJECTIVE:

The purpose of this study was to assess anal/vaginal human papillomavirus and anal dysplasia prevalence in patients with IBD.

DESIGN:

Patients had an anal examination before routine colonoscopy.

SETTINGS:

The study was conducted at a tertiary IBD referral center.

PATIENTS:

We studied a convenience sample of sexually active male and female patients with IBD who were not on biological therapy.

INTERVENTION:

Anal examination, anal and vaginal human papillomavirus testing, anal cytology, and high-resolution anoscopy/biopsy were carried out.

MAIN OUTCOME MEASURES:

Anal and vaginal human papillomavirus types, anal cytology, and biopsy grade were measured.

RESULTS:

Twenty-five male and 21 female evaluable participants, 31 with Crohn’s disease, 14 with ulcerative colitis, and 1 with indeterminate colitis, were predominantly white (91.3%), treatment experienced (76.1%), an average age of 38.1 years (range, 22.0–66.0 y), and had an average length of IBD diagnosis of 9.3 years (range, 1.0–33.0 y). Eighteen (39.1%) had an abnormal perianal examination and 3 (6.5%) had an abnormal digital examination. Forty-one (89.1%) had anal human papillomavirus, 16 with a single type and 25 with multiple types (range, 2–5 types). Human papillomavirus type 16 was most common (65.2%), followed by human papillomavirus types 11 and 45 (37.0% each). Nineteen of 21 (90.5%) women had vaginal human papillomavirus. Overall, 21 (45.7%) had abnormal anal cytology. Thirty three (71.7%) had ≥1 anal biopsy (9 had multiple), with dysplasia diagnosed in 28 (60.9%) and high-grade and low-grade squamous intraepithelial lesions diagnosed in 4 (8.7%) and 24 (43.5%).

LIMITATIONS:

No control group was included, and no detailed sexual history was taken.

CONCLUSIONS:

A high prevalence of anal and vaginal human papillomavirus and anal dysplasia was demonstrated in the study population outcomes. See Video Abstract at http://links.lww.com/DCR/A379.

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