Uncovering a hidden burden: HPV-related anal cancer risk amongst women living with HIV in Brazil, preliminary data from a cross-sectional study

Purpose Women living with HIV (WLWHIV) are at increased anal cancer risk; data on histologically confirmed anal HSIL in LMICs are limited. We estimated high resolution anoscopy (HRA)-confirmed anal high-grade squamous intraepithelial lesion (HSIL) prevalence at a Brazilian referral center. Methods WLWHIV ≥ 35 years from Rio de Janeiro underwent HRA-guided biopsy at INCA (2023–2025). Primary outcome: prevalence of histologically confirmed anal HSIL (LAST). Logistic regression identified predictors. Results Of 151 enrolled, 144 had biopsies; 66 had HSIL (45.8% of biopsied; 43.7% overall). Lower CD4 count was the only independent predictor (CD4 > 500 vs. ≤ 500 cells/µL: aOR 0.32, 95% CI 0.13–0.78; p = 0.012). Anal cytology sensitivity was 35.1% for ASC-US+ with minimal agreement vs. biopsy (Cohen’s κ = 0.023). Conclusion HRA-confirmed anal HSIL prevalence was high among WLWHIV; lower CD4 count was the only correlate identified, although HSIL was also frequent with CD4 > 500 cells/µL. Anal cytology performed poorly as a stand-alone test.