Open AccessInitiation of an anal cancer screening in HIV+MSM: results of cytology, biopsy and determination of risk factors
Author(s) -
Libois A,
Feoli F,
Nkuize M,
Delforge M,
De Wit S,
Clumeck N
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.6.18436
Subject(s) - medicine , anal cancer , squamous intraepithelial lesion , men who have sex with men , cytology , biopsy , incidence (geometry) , gastroenterology , gynecology , cancer , viral load , human immunodeficiency virus (hiv) , pathology , cervical cancer , cervical intraepithelial neoplasia , immunology , physics , syphilis , optics
Incidence of anal cancer is increasing and risk of anal cancer is higher in MSM, especially if they are HIV+. European guidelines for treatment of HIV‐infected adults recommend anal cancer screening by digital rectal exam±Pap test with anuscopy if Pap test is abnormal. A systematic anal cancer screening in HIV+MSM with anal cytology (Pap smears) was established in June 2011 in our reference centre in Brussels. If anal cytology was abnormal, high‐resolution anuscopy (HRA) with biopsy was performed. 353 MSM HIV+were screened by anal smears between June 2011 and May 2012. 90% were Caucasians, median age was 44.5 years, 83% were on HAART and 74% had an undetectable viral load, median CD4 was 632/µl and 33% had a nadir CD4<200. Thirty‐three (9.3%) were excluded because of poor quality. Cytology was abnormal in 46% of the 320 remaining patients: high‐grade squamous intraepithelial lesion (HSIL) 3%, low‐grade squamous intraepithelial lesion (LSIL) 24%, atypical squamous cells of undetermined significance (ASC‐US) 16%, and atypical squamous cells / cannot rule out a high‐grade lesion (ASC‐H) 3%. Viral load (VL) was more frequently undetectable (82% vs 64%, p=0.0003) and median duration of HAART was longer (111 vs 61 months, p=0.0145) in patients with normal cytology. 80 HRA with biopsies have been performed. 12.5% were normal, 44% showed anal intraepithelial neoplasia (AIN) 1, 24% AIN 2 and 19% AIN 3. For this analysis, high‐grade AIN (2 and 3) were put together (AIN 2+). Among patients with AIN 2+(n=33), cytology had showed 8 (24%) ASC‐US, 3 (9%) ASC‐H, 19 (57%) LSIL, 3 (9%) HSIL. When patients with normal cytology or normal biopsy and patients with AIN 2+were compared, the only significant risk factor found for AIN 2+was a nadir CD4<100/µl (32% of the patients with AIN 2+vs 14% in patients with normal smear, p=0.0073). Anal precancerous lesions are frequent and at different stages. Among 46% abnormal cytology, 87% had abnormal biopsy including half AIN 2+.Cytology±biopsy is the only way to detect those lesions and should be performed systematically in HIV+MSM. Risk factor for AIN2+was a nadir CD4<100/µl. A normal cytology was associated with an undetectable VL and a longer duration of HAART. Those results provide further argument for early initiation of HAART.