Risk factors for anal dysplasia among privately insured HIV-negative women

Objective: To examine the relationship between anogenital abnormalities and the development of anal dysplasia
among Human Immunodeficiency Virus (HIV)-negative women.
Methods: This retrospective matched case-control study used administrative data from the 2009-2014 Clinformatics
Data Mart. Cases were selected according to the International Classification of Diseases, Ninth Revision, using Clinical
Modification codes for carcinoma in situ of the anal canal or anus unspecified, anal intraepithelial neoplasia 1 and 2,
abnormal glandular Papanicolaou (Pap) smear of the anus, or Pap smears of the anus with atypical squamous cells,
squamous intraepithelial lesions, or cytological evidence of malignancy. Conditional logistic regression analysis was
used to calculate odds ratios (ORs) and 95% confidence intervals for the risk of anal dysplasia.
Results: The study included 3,384 HIV-negative women (846 cases and 2,538 controls), mean age 50.1 ± 11.9
years. The odds of being a smoker, having cervical intraepithelial neoplasia (CIN), or anogenital warts were higher for
HIV-negative women with anal dysplasia than for those without anal dysplasia (OR =2.5-16.3).
Conclusions: HIV-negative women with anal dysplasia are more likely to have concomitant human papillomavirus
(HPV)-related CIN and anogenital warts than women without anal dysplasia. The presence of HPV-associated lesions
might have implications for future screening recommendations. HIV-negative women with a history of CIN and anogenital
warts could benefit from anal dysplasia/anal cancer screening. Gaining a better understanding of the natural history of
anal HPV infections will provide tools to better treat and counsel patients with anal dysplasia.