Anal High-Risk HPV Genotype Prevalence: Unmasking Racial, Gender, and HIV-Related Disparities

Summary: Introduction: Cancer screening with anal cytology in high-risk populations has gained acceptance for cancer prevention. As anal cancer is HPV-driven, vaccination in high-risk groups is recommended for cancer prevention. Racial differences in hr-HPV genotype prevalence have been identified in cervical HPV genotypes, however there is limited knowledge about distribution in anal cytology samples. This study examines demographic and cytopathologic features of a racially/ethnically and gender diverse anal HR-HPV positive patient cohort. Materials and Methods: Anal hr-HPV positive patients from a single, ethnically diverse hospital were identified between 2022-2023. Corresponding demographics, clinical features, and cytologic interpretations were compared amongst ethnic groups, straight/cis-gender identifying versus sexual and gender minority (SGM) patients, and patients living with HIV versus HIV negative patients. Results: 97 patients were positive for HPV 16, HPV 18, non 16/18 hr-HPV genotypes, or multiple genotypes. Most patients identified as Hispanic (42%), then non-Hispanic, White (30%), then African American (12%), then Asian (10%). 65% of the cohort identified as an SGM. 84% of the cohort was living with HIV and 6% had a history of HPV vaccination (Table 1). No differences in hr-HPV genotype distribution were identified amongst ethnic groups or between straight, cis-gender and SGM patients (Tables 2-3). Patients living with HIV were more likely to have atypical cytology as compared to HIV-negative patients (Table 4). Patients living with HIV were also more likely to have a non 16/18 hr-HPV genotype (54%) as compared to HIV-negative patients (27%, p-value: 0.02). Conclusions: This data supports prior studies that patients living with HIV more commonly have atypical cytopathology. It also suggests patients living with HIV are more likely to have non 16/18 hr-HPV strains. No differences in distribution of hr-HPV strains amongst ethnic groups or between cis-gender, straight patients and SGM patients were noted. Additional work is needed to ensure that the most prevalent strains of hr-HPV in HIV-positive patients are covered by HPV vaccination.