Annual cancer screenings warranted for women living with HIV, reports US trial

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Clinicians treating people who are living with HIV have traditionally focused on men when considering the risk of pre-cancerous anal lesions, but data increasingly show that anal cancer screenings may be warranted in women living with HIV (WLWH) as well. A newly published study underscores this trend.

About This Study

Two-Year Incidence and Cumulative Risk and Predictors of Anal High-Grade Squamous Intraepithelial Lesions (anal precancer) among Women with HIV” was published online on Oct. 8, 2023, in Clinical Infectious Diseases. The lead author is Elizabeth A. Stier, M.D., of the Department of Obstetrics and Gynecology at Boston University Chobanian & Avedisian School of Medicine in Boston, Massachusetts.

Key Research Findings

Researchers in The AIDS Malignancy Consortium (AMC 084) study, a multi-center, national trial, investigated the incidence of anal histologic high-grade squamous intraepithelial lesions (hHSIL), which can lead to cancer, in WLWH from 2014-2016. They also assessed the performance of anal high-risk human papillomavirus (hrHPV) testing and/or anal cytology (anal-cyt) exams in detecting such lesions.

Data came from 229 WLWH in 12 U.S. cities, 114 of whom did not have prevalent lesions at baseline. Participants without lesions were followed semiannually for two years. Sixty-three percent of participants were Black, 23% were Latinas, and the median age was 51 years. Abnormal cervical cytology was common (48% of participants), as was anal sex with a man (58% of participants), and having experienced sexual assault (45% of participants).

Overall, anal hHSIL incidence was 8.5/100 person-years (PY) but the incidence was significantly higher among participants with baseline abnormal anal-cyt (13.4/100 PY) or positive hrHPV (18.4/100 PY). Two-year cumulative incidence was >18% in participants with normal baseline results, while it was 59% in women with abnormal anal-cyt, and 52% in participants with hrHPV.

Results did not differ by race/ethnicity, age, or smoking status. Combining HPV testing and cytology would still miss around 10% of lesions because the tests used are optimized for cervical specimens.

Discussion Highlights and Implications for Practice

Study limitations reported included a relatively high rate of loss to follow-up and small sample sizes for incident anal hHSIL or HPV16 cases, which limit the study’s power. In addition, there was no centralized review of the cytology interpretations and researchers used commercial non-PCR based hrHPV assays.

The researchers stated that while anal HPV testing and cytology can find pre-cancerous lesions in WLWH, normal results on both tests do not necessarily mean no lesions exist. Additional biomarkers and/or more sensitive tests are needed to exclude hHSIL. Annual anal cancer screenings could be helpful in WLWH, especially in women with cervical HPV16 or abnormal cervical cytology, they concluded.

By Barbara Jungwirth

 

Source : TheBodyPro

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