A 12-year retrospective evaluation of anal pre-cancerous lesions and cancer in people living with HIV-1 infection in the Southeastern U.S

Abstract

Background Anal cancer is rare in the general population in both genders in the US, but an increased incidence of anal cáncer (AC) has been reported among people living with HIV-1 infection (PLWH) and little is known among the population in South US. Methods In a retrospective study design, electronic health records from 2006 to 2018 were reviewed in a HIV clinical cohort at the University of Alabama at Birmingham. Associations of demographic, sociodemographic, and HIV-clinical indicators were examined in univariate analyses between high-grade squamous intraepithelial lesions (HSIL) and AC cases and condition-free individuals. Factors for anal/rectal cytology screening tests among PLWH were also assessed over time. Ages at onset of anal cancer were compared with the general US population reported by the National Surveillance, Epidemiology, and End Results Program. Results A total of 79 anal HSIL (96% men) and 43 cancer (100% men) patients were observed along with 4367 HSIL/cancer-free patients (75.9% men). HSIL (P < 0.0001) and AC (0.0001 < P < 0.01) were associated with being men who have sex with men (MSM). An incidence of 258 per 100,000 person-year was observed among this clinical cohort of PLWH. PLWH who were 45–54 years appeared to be at highest risk of AC (58.1%), as compared to those 55–64 years in the general population. Overall, 79% of PLWH anal cancers were diagnosed among those under 55 years (vs 39.5% in general population) indicating early onset of AC. In total 29.1% of HSIL and 44.2% of AC patients had not received an anal/rectal cytology examination 1 year prior to diagnosis. Conclusion AC incidence among HIV-infected men was 161 times higher than general population with an earlier age of onset/diagnosis. Many patients with AC had missed screening opportunities that could potentially have captured neoplasia in pre-cancerous stages. AC-related screening guidelines need to be integrated into routine clinical care, especially among PLWH at highest risk such as MSM and those with lower CD4 counts.

Excess cancer prevalence in men with HIV: A nationwide analysis of Medicaid data

“…Consistent with previous studies, the prevalence of anal cancer was higher among MLWH compared with their non‐HIV counterparts, and this association was stronger in the younger age group 13,14 (nearly 500 times higher in the younger age group vs 36 times higher in the older age group). These findings suggest that the burden of anal cancer is of much greater magnitude than previously described in PLWH, although most prior studies have reported hazard or risk ratios rather than prevalence ratios, as we do in this study 14,24,25 …”

“…These findings suggest that the burden of anal cancer is of much greater magnitude than previously described in PLWH, although most prior studies have reported hazard or risk ratios rather than prevalence ratios, as we do in this study. 14,24,25 Our findings also showed variations in excess cancer prevalence by HIV symptomatic status and across cancer sites. MLWH experienced higher cancer prevalence than men without HIV for most cancer types, whether they were in the symptomatic or asymptomatic groups.…”

“…A previous study demonstrated that non–AIDS‐defining cancer was the leading non‐AIDS cause of death in PLWH, 9 responsible for 10‐17% of deaths in PLWH 10,11 . Although the cancer burden in the United States is expected to increase as the population ages, 12 it may affect PLWH more acutely because they are generally diagnosed with cancer 10 to 20 years earlier than people without HIV 13,14 . This is caused in part by premature aging, 15 compromised immune function, and a high prevalence of non‐HIV cancer risk factors (eg, smoking and coinfection by oncogenic viruses, such as human papillomavirus [HPV]) 16…”

“…10,11 Although the cancer burden in the United States is expected to increase as the population ages, 12 it may affect PLWH more acutely because they are generally diagnosed with cancer 10 to 20 years earlier than people without Cancer May 15, 2022 HIV. 13,14 This is caused in part by premature aging, 15 compromised immune function, and a high prevalence of non-HIV cancer risk factors (eg, smoking and coinfection by oncogenic viruses, such as human papillomavirus [HPV]). 16 HIV disproportionately affects persons of color, men who have sex with men, transgender women, those who inject drugs, and those with lower socioeconomic status.…”

Development of a multivariable prediction model for anal high-grade squamous intraepithelial lesions in persons living with HIV in Puerto Rico: a cross-sectional study

“…9 Furthermore, previous evidence suggests that HR-HPV infection, such as HPV-16, is implicated in nearly 90% of anal cancer cases. 10 , 11 All these factors have made anal cancer an increasingly concerning but preventable malignancy. Other risk factors for anal cancer include immunosuppression due to solid-organ transplantation, history of vulvar or cervical HSIL or cancer, history of receptive anal intercourse, history of genital warts, anal fissures or fistulas and smoking.…”