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Anal Cancer Screening in HIV-Infected Patients: Is It Time to Screen Them All?

Mallari, Alexander O. M.D.1; Schwartz, Theresa M. M.S., N.P-C., A.A.H.I.V.S.2; Luque, Amneris E. M.D.3; Polashenski, Pamela S. M.D.1; Rauh, Stephen M. M.D.4; Corales, Roberto B. D.O., A.A.H.I.V.S.5

doi: 10.1097/DCR.0b013e31826ab4fb
Original Contribution: Colorectal/Anal Neoplasia

BACKGROUND: Annual screening for anal cancer is recommended only for HIV patients at increased risk: men who have sex with men, individuals with a history of anogenital warts, and women with cervical dysplasia.

OBJECTIVE: The aim of this study was to examine the screening outcomes between HIV populations with and without these risk factors.

METHODS: We reviewed the records of all HIV patients referred for anal cytology and high-resolution anoscopy from June 2009 to June 2010. Patients were stratified into an increased-risk group or a standard-risk group.

MAIN OUTCOME: Of the 329 evaluable patients, 285 (89.8% men, 10.2% women, mean age 46 ± 10 years) were classified to the increased-risk group, whereas 44 (72.7% men, 27.3% women, mean age 52 ± 8 years) were included in the standard-risk group. Male sex, white race, sexual orientation, past and current receptive anal intercourse, noncompliance with condom use, and absence of a new sexual partner were significantly different in the increased-risk group in comparison with the standard-risk group. In the increased-risk group, 187 (66.5%) patients had biopsy-proven dysplasia of which 118 (42.0%) had high-grade disease. In the standard-risk group, 15 (34.9%) patients had biopsy-proven dysplasia of which 7 (16.3%) had high-grade disease. Cytology detected biopsy-confirmed high-grade dysplasia only in 23 of 118 (19.5%) patients in the increased-risk group and in 2 of 7 (28.6%) patients in the standard-risk group. Kappa agreement in detecting high-grade disease was low for both increased-risk and standard-risk groups: 0.16 (95% CI 0.07–0.23) and 0.40 (95% CI 0.02–0.40).

LIMITATIONS: Our study is a chart-based retrospective review of data with a small female population. Histology reports came from 2 different laboratories.

CONCLUSION: High-grade anal dysplasia was prevalent even among HIV patients who only have standard risk factors. Anal cytology and high-resolution anoscopy have poor agreement. We suggest considering annual screening by using high-resolution anoscopy in addition to cytology for all HIV patients regardless of risk factors.

1 Department of Medicine, Rochester General Hospital, Rochester, New York

2 Anal Dysplasia Clinic, University of Rochester Medical Center, Rochester, New York

3 Infectious Diseases Division, University of Rochester Medical Center, Rochester, New York

4 Department of Surgery, University of Rochester Medical Center, Rochester, New York

5 AIDS Care, Rochester, New York

Poster presentation at the International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention, Rome, Italy, July 17 to 20, 2011.

Financial Disclosures: None reported.

Correspondence: Alexander O. Mallari, M.D., 1425 Portland Ave, Rochester NY 14621. E-mail:

© The ASCRS 2012