Anal Dysplasia Screening and Treatment in a Southern Human Immunodeficiency Virus Clinic

Willeford, Wesley G; Barroso, Luis F.; Keller, Jennifer; Fino, Nora; Bachmann, Laura H.

doi:10.1097/olq.0000000000000475

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…In this prospective study of HIV+ MSM undergoing a screening/treatment program for anal mucosa dysplasic lesions, the presence of �high-grade anal intraepithelial lesions were related to infection by HPV genotypes 11 16, 18, 53, 61 and 68, a low CD4 nadir and a history of AIDS. This finding of a relationship between HSIL-positivity and poor immunological status is consistent with previous observations that prolonged antiretroviral treatment [21][22][23] and a high CD4 count, regardless of CD4 nadir [24], are protective factors against HSIL. A recent prospective study observed a similar incidence of HPV-16 and -18 genotypes in the anal PLOS ONE mucosa of French HIV+MSM, but HPV-16 was more persistent and therefore more closely correlated with the presence of HSIL [25].…”

Section: Discussionsupporting

confidence: 92%

Risk factors for ≥high-grade anal intraepithelial lesions in MSM living with HIV and the response to topical and surgical treatments

et al. 2021

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Background The objective of this study in MSM living with HIV was to determine the incidence of HSIL and ASCC, related factors, and the response to treatment. Patients and methods Data were gathered in 405 consecutive HIV-infected MSM (May 2010-December 2018) at baseline and annually on: sexual behavior, anal cytology, and HPV PCR and/or high-resolution anoscopy results. They could choose mucosectomy with electric scalpel (from May 2010) or self-administration of 5% imiquimod 3 times weekly for 16 weeks (from November 2013). A multivariate logistic regression model was developed for ≥HSIL-related factors using a step-wise approach to select variables, with a significance level of 0.05 for entry and 0.10 for exit, applying the Hosmer-Lemeshow test to assess the goodness of fit. Results The study included 405 patients with a mean age of 36.2 years; 56.7% had bachelor´s degree, and 52.8% were smokers. They had a mean of 1 (IQR 1–7) sexual partner in the previous 12 months, median time since HIV diagnosis of 2 years, and mean CD4 nadir of 367.9 cells/uL; 86.7% were receiving ART, the mean CD4 level was 689.6 cells/uL, mean CD4/CD8 ratio was 0.77, and 85.9% of patients were undetectable. Incidence rates were 30.86/1,000 patient-years for ≥high squamous intraepithelial lesion (HSIL) and 81.22/100,000 for anal squamous cell carcinoma (ASCC). The ≥HSIL incidence significantly decreased from 42.9% (9/21) in 2010 to 4.1% (10/254) in 2018 (p = 0.034). ≥HSIL risk factors were infection with HPV 11 (OR 3.81; 95%CI 1.76–8.24), HPV 16 (OR 2.69, 95%CI 1.22–5.99), HPV 18 (OR 2.73, 95%CI 1.01–7.36), HPV 53 (OR 2.97, 95%CI 1.002–8.79); HPV 61 (OR 11.88, 95%CI 3.67–38.53); HPV 68 (OR 2.44, CI 95% 1.03–5.8); low CD4 nadir (OR1.002; 95%CI 1–1.004) and history of AIDS (OR 2.373, CI 95% 1.009–5.577). Among HSIL-positive patients, the response rate was higher after imiquimod than after surgical excision (96.7% vs 73.3%, p = 0.009) and there were fewer re-treatments (2.7% vs 23.4%, p = 0.02) and adverse events (2.7% vs 100%, p = 0.046); none developed ASCC. Conclusions HSIL screening and treatment programs reduce the incidence of HSIL, which is related to chronic HPV infection and poor immunological status. Self-administration of 5% imiquimod as first-line treatment of HSIL is more effective than surgery in HIV+ MSM.

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Section: Discussionsupporting

confidence: 92%

Risk factors for ≥high-grade anal intraepithelial lesions in MSM living with HIV and the response to topical and surgical treatments

et al. 2021

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“…All other authors declare no competing interests. (22, 23, 30-32, 34-36, 38, 41-43, 85-101) N populations 29 18 17 6 8 4 N PLHIV 7750 5311 4487 1107 2505 1745 ASCUS-AIN1+ prevalence (26-28, 32-35, 102-126) N populations 37 28 20 10 11 2 N PLHIV 8790 6782 5342 1720 2198 351 HSIL-AIN2+ prevalence (30,31,(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(127)(128)(129)(130)(131)(132)(133)(134)(135)(136)(137) N populations 23 15 16 6 5 7…”

Section: Declaration Of Interestsmentioning

confidence: 99%

Association of antiretroviral therapy with anal high-risk human papillomavirus, anal intraepithelial neoplasia, and anal cancer in people living with HIV: a systematic review and meta-analysis

et al. 2020

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BACKGROUND: The effect of antiretroviral therapy (ART) on the natural history of anal HR-HPV and anal lesion progression is not well established. We reviewed the association of ART and other HIV-related factors on anal HPV infection, anal intraepithelial neoplasia (AIN), and anal cancer among people living with HIV (PLHIV). METHODS: We searched Medline and Embase for studies from 1 January 1996 to 30 October 2019 that reported the association of HIV-related exposures (ART, HIV-RNA plasma viral load [PVL] and nadir or current CD4+ cell count) with outcomes of anal HR-HPV prevalence, incidence or persistence or prevalence, incidence, progression or regression of anal histological/cytological abnormalities, or anal cancer incidence. We assessed the risk of bias of included studies using the Newcastle-Ottawa scale. We performed random-effects meta-analyses; heterogeneity was examined using I 2 statistic. FINDINGS: 122 studies were included comprising 417,006 PLHIV (19%, 44% and 5% women, men-whohave-sex-with-men; men-who-have-sex-with-women, respectively; 32% of studies did not stratify findings by gender and/or sexual orientation). PLHIV taking ART had 35% lower HR-HPV prevalence compared to ART-naïve (crude Odds Ratio[cOR]=0.65, 95%CI:0.54-0.79; I 2 =12.1%) in 18 studies and prolonged ART use was associated with a 10% reduction in HR-HPV prevalence in two studies (per year: aOR=0.90, 95%CI:0.85-0.95, I 2 =0.0%). PLHIV with undetectable PVL had lower HSIL/AIN2+ prevalence compared to those without (cOR=0.84, 95%CI:0.72-0.98, I 2 =0.0%) in 16 studies, particularly if sustained for >1 year (cOR=0.62, 95%CI:0.47-0.81, I 2 =0.0%). ART was not associated with anal cancer incidence when adjusted for years living with HIV in 3 studies (aHR=1.11, 95%CI: 0.68-1.80, I 2 =0.0%), but ART users with sustained undetectable HIV PVL had 44% lower risk of anal cancer compared to those without (aHR=0.56, 95%CI:0.44-0.70, I 2 =0%) and for each 100 cells/µl increase in nadir CD4+ count, there was a 40% decrease in anal cancer incidence (cHR=0.60, 95%CI:0.46-0.78, I 2 =21.7%). INTERPRETATION: Effective ART use and early initiation at higher nadir CD4+ may reduce anal HR-HPV and anal cancer risk.

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“…Willeford et al have noted significantly less follow-up with young black men, which is associated with higher rates of high-grade anal dysplasia. 16 Failure to follow up with SCCA would also lead to lower survival.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities and the Effect of County Level Income on the Incidence and Survival of Young Men with Anal Cancer

2018

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Purpose: Prior studies have identified a racial disparity in incidence and survival of squamous cell carcinoma of the anus (SCCA) in the young African American male population. We aim to determine whether racial disparities are independent of income and urban location.Methods: The National Cancer Institute's Surveillance of Epidemiology and End Results database was queried for data on patients with SCCA for the years of 2000–2013. Cox regression was used to determine the effect of race, county median family income, rural–urban continuum, and stage of disease on overall survival.Results: The incidence rate of SCCA was significantly higher in black men <50 years old than in white men. Black race had a hazard ratio of 1.55 (confidence interval [CI] 1.33–1.81) when controlling for age, stage, income, and urban–rural status. Each $10,000 increase in county median family income was protective with a hazard ratio of 0.90 (CI 0.86–0.94). Residence in a metropolitan area did not significantly affect survival.Conclusions: The lower survival of black men <50 years old with SCCA is independent of income, urban location, and stage of disease. Further efforts are needed to target this at-risk population and the authors suggest wide application of previously validated screening programs for anal dysplasia.

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Anal Dysplasia Screening and Treatment in a Southern Human Immunodeficiency Virus Clinic

Cited by 6 publications

References 18 publications

Risk factors for ≥high-grade anal intraepithelial lesions in MSM living with HIV and the response to topical and surgical treatments

Risk factors for ≥high-grade anal intraepithelial lesions in MSM living with HIV and the response to topical and surgical treatments

Association of antiretroviral therapy with anal high-risk human papillomavirus, anal intraepithelial neoplasia, and anal cancer in people living with HIV: a systematic review and meta-analysis

Racial Disparities and the Effect of County Level Income on the Incidence and Survival of Young Men with Anal Cancer

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