Introduction:Non-AIDS defining cancers are the second leading cause of death in HIV-infected individuals, and colorectal cancer is the fourth leading cancer among HIV-infected individuals. The optimal approach to colorectal cancer screening in HIV-infected individuals is yet to be defined.
Methods:We collected clinical data and colonoscopy results on 263 HIV-infected patients matched with 657 non-HIV-infected patients on age, race, and sex to compare the prevalence, type, and location of colorectal neoplastic lesions. Frequency distributions and descriptive statistics were used to characterize the study population. The primary exposure was HIV infection, and the primary outcome was any adenoma or adenocarcinoma. Logistic regression models were used to estimate odds ratios with 95% confidence intervals (CI).
Results:HIV-infected patients were less likely to have any adenoma (22% vs. 27.9%, P = 0.04), tubular adenomas >10 mm (0.4% vs. 2.9%, P = 0.02), and serrated adenomas (0.0% vs. 2.6%, P ≤ 0.01). There was no difference in the prevalence of adenocarcinoma in HIV-infected patients compared to non-HIV-infected individuals (1.5% vs. 0.8%, P = 0.29). The lower risk of any adenoma remained after controlling for age, sex, smoking status, body mass index (BMI), and diabetes mellitus [adjusted odds ratio (aOR), 0.61; 95% (CI): 0.43 to 0.88]. When stratified by diabetes mellitus, HIV-infected patients without diabetes mellitus had the lowest risk (aOR, 0.47; 95% CI: 0.31 to 0.71). Conclusions: HIV- infected patients had a lower prevalence of colorectal neoplastic lesions, including high risk adenomas, than non-HIV-infected patients. Earlier screening for colorectal cancer is not indicated in this population.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.