) Human papilloma virus (HPV) infection of the genital tract of women is an important health care problem. Conservative estimates place the incidence at approximately 5 percent of women screened by Pap smears annually. The cost of evaluating and treating these women has been estimated to exceed 6 billion dollars annually. While significant insights have been gained into the molecular pathogenesis and epidemiology of HPV infection, several important clinical issues are not yet resolved. One such issue is the risk of developing anal premalignant neoplasias and cancer in women with genital HPV infection. The hypothesis to be tested by this grant proposal is that women with squamous intraepithelial lesions (SIL) of the cervix are at significant risk for having anal SIL. The proposed research is meant to serve as a pilot study to address this hypothesis. As such, the study will address the following Specific Aims. 1. Determine the frequency of anal SIL in immunocompetent women with and without cervical SIL. 2. Determine the correlation between the grade of cervical SIL and the grade of anal SIL. 3. Determine the correlation between anal HPV infection and the presence of anal disease, and the correlation between HPV types isolated from the cervix and anus. 4. Assess the sensitivity of anal cytology for detection of anal SIL in immunocompetent women. If the completion of these Specific Aims confirms the hypothesis that women with cervical HPV disease are at risk for having significant anal disease due to HPV, it will provide the framework for designing a more detailed investigation into associated cofactors and a prospective study of the natural history of these lesions in immunocompetent women.
