Screening for Squamous Cell Anal Cancer in HIV Positive Patients: A Five-Year Experience

ABSTRACT

Aim: Potential screening modalities for early diagnosis of squamous cell anal cancer (SCC) in HIV patients include digital anorectal examination (DARE), anal Papanicolaou testing (Pap test), human papilloma virus (HPV) co-testing, and high-resolution anoscopy. The aim of this study was to demonstrate the results of a five-year screening program for SCC in HIV patients. Materials and Methods: We conducted a retrospective study on 204 HIV patients who underwent a screening program for SCC from October 2010 to January 2015. All patients were screened by DARE, anal Pap test, including HPV test and cytology, and high-resolution video-proctoscopy (HR-VPS) with and without acetic acid 3%. Depending on macroscopic appearance and biopsies, patients underwent observation or treatment. Median follow-up was 36 months. Results: Cytologic abnormalities (Cyt+) for high-risk HPV genotypes were recorded in 34% of patients. HR-VPS was positive in 59 patients (29%), of whom 13 patients (22%) were positive for warts; the rest have typical features of anal intraepithelial neoplasia (AIN). Sixteen (8%) patients had AIN (AIN I–III) and underwent wide local excision, ablation, or imiquimod. Absence of progression was recorded. Fourteen patients (7%) had SCC: eight (57%) with no evidence of recurrence, two (14%) had recurrence, and four (29%) died from metastatic disease. Conclusions: Our data demonstrated a successful screening program in preventing SCC in HIV patients. We demonstrate the advantages of progression towards SCC. Moreover, we used a new screening tool, the HR-VPS, a low-cost and manageable instrument to collect patients' long-term data.

Keywords::

• HIV
• HPV
• anal dysplasia
• high-resolution video-proctoscopy
• screening
• anal cancer

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

FUNDING

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

RESEARCH ETHICS AND PATIENT CONSENT

We performed a retrospective local service evaluation. Our local institutional board approved the study. Patient consent was not required.

AUTHORS' CONTRIBUTIONS

CS and CAL have contributed to design of the study, acquisition of data, analysis and interpretation of data, and drafting/ revising the manuscript critically for important intellectual content. JDH, FC, and FB have contributed to the design and interpretation of data and revising the manuscript. EC has contributed to the conception and design, acquisition of data, analysis and interpretation of data, drafting/ revising the manuscript critically for important intellectual content. All authors contributed provided a final approval of the version to be published.