ArticleFrontiers in immunology2026
Stratifying the risk of anal high-grade squamous intraepithelial lesion among immunosuppressed women with genital HPV.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Immunosuppressed women with human papillomavirus (HPV)-related genital disease are at increased risk of anal squamous cell carcinoma (ASCC), yet optimal risk stratification and screening strategies remain poorly defined. The aim of this study was to evaluate the prevalence of anal high-grade squamous intraepithelial lesions/anal intraepithelial neoplasia (HSIL/AIN), determine whether the anatomical distribution of genital HPV-associated disease provides clinically relevant information for risk stratification, and to assess the diagnostic performance of different screening strategies in this high-risk population. Methods: A total of 100 immunosuppressed women undergoing ASCC screening were included. All women underwent anal high-risk HPV testing and genotyping and liquid-based cytology, followed by high-resolution anoscopy when indicated. Results: Anal HPV infection was detected in 77.0% of women, and histologically confirmed HSIL/AIN was detected in 33.0% of the overall cohort. The proportion of women with HSIL/AIN differed according to the anatomical distribution of HPV-related genital lesions. Women with vulvar HSIL, either as isolated disease (52.6%) or as part of multizone HSIL (64.3%), showed the highest proportion of detected HSIL/AIN, whereas HSIL/AIN was detected less frequently among women with HPV infection without genital HSIL (22.2%) (p=0.037 and p=0.007, respectively). Anal HPV testing alone showed high sensitivity (97.0%; 95% CI: 84.2-99.9) and negative predictive value (95.7%; 95% CI: 78.1-99.9), whereas combined strategies slightly increased sensitivity at the expense of lower specificity and higher referral rates. Discussion: In conclusion, the anatomical distribution of HPV-associated genital disease appears to provide clinically relevant risk stratification. Women with vulvar HSIL represent a priority subgroup for ASCC screening. Anal HPV testing alone showed high sensitivity and NPV. These findings suggest that anal HPV testing may represent a useful primary screening approach in this population.
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