Routine Screening of Anal Cytology in Persons With Human Immunodeficiency Virus and the Impact on Invasive Anal Cancer: A Prospective Cohort Study

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>The efficacy of screening programs to prevent anal cancer in persons with human immunodeficiency virus 1 (HIV-1) is unclear.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>To examine the impact of a screening program to detect anal cancer precursors on the incidence of cases of invasive anal squamous-cell carcinoma (IASCC) in persons with HIV-1, we performed a single-center, retrospective analysis of a prospective cohort of outpatients with HIV-1 attending a reference HIV unit from January 2005 onward. All participants were invited to participate in a continued structured screening program for anal cancer prevention. We estimated the incidence of IASCC and performed a comparative analysis between subjects enrolled in the screening program (screening group) and those who declined to participate (nonscreening group). To reduce any selection bias, a propensity score analysis was applied.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>We included 3111 persons with HIV-1 (1596 men-who-have-sex-with-men [MSM], 888 men-who-have-sex-with-women [MSW], 627 women; mean age, 41 years), with a median follow-up of 4.7 years (14 595 patient-years of follow-up); 1691 (54%) participated in the screening program. Ten patients were diagnosed with IASCC: 2 (MSM) in the screening group and 8 (4 MSM, 2 MSW, and 2 women) in the nonscreening group. The incidence rates of IASCC were 21.9 (95% confidence interval [CI], 2.7–70.3) and 107.0 (95% CI, 46.2–202.0) per 100 000 person-years, respectively. After a propensity score adjustment, the difference was significant in favor of the screening group (hazard ratio, 0.17; 95% CI, .03–.86).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The number of cases of IASCC was significantly lower in persons with HIV engaged in an anal cytology screening program. These results should be validated in a randomized clinical trial.</jats:p> </jats:sec>

HIV‐Medizin in der Dermatologie und Venerologie

“…Aktuell untersucht eine prospektive Studie (ANCHOR) die Effektivität von analen IN-Screenings. Große retrospektive Studien zeigen, dass anales Screening und frühzeitige Behandlung von HPV-assoziierten Läsionen die Inzidenz von Karzinomen reduzieren [29,30]. Auf regelmäßige Hautkrebsscreenings unter Zuhilfenahme der Auflichtmikroskopie [31] sollte auch bei der Betreuung von HIV + geachtet werden.…”

Anal cancer prevention: Solving the puzzle piece by piece

“…Cancer April 1, 2020 not screened at all. 9 The incidence of cancer was found to be higher in the no-screening group. After propensity score adjustment, screening and treatment were found to be significantly protective against cancer, with a hazard ratio of 0.17 (95% CI, 0.03-0.86).…”

“…The incidence of cancer was found to be higher in the no‐screening group. After propensity score adjustment, screening and treatment were found to be significantly protective against cancer, with a hazard ratio of 0.17 (95% CI, 0.03‐0.86) . Cajas‐Monson et al reported on a large series of patients with HSIL being treated with a “watch‐and‐wait approach,” whereby the HSIL was largely untreated but watched closely for progression .…”

“…After propensity score adjustment, screening and treatment were found to be significantly protective against cancer, with a hazard ratio of 0.17 (95% CI, 0.03-0.86). 9 Cajas-Monson et al reported on a large series of patients with HSIL being treated with a "watch-and-wait approach," whereby the HSIL was largely untreated but watched closely for progression. 10 They followed 341 PLWH with HSIL for a mean of 5.6 years, 24 of whom (7.0%) developed 46 ASCCs for an incidence of 1.3% per patient-year.…”

“…Gaisa et al found no cases of cancer after a median follow‐up of >1 year but out to as long as 7.8 years in >300 participants . Another very recent series from Barcelona examined >3000 patients with HIV who either were screened and treated for HSIL or not screened at all . The incidence of cancer was found to be higher in the no‐screening group.…”