Netherlands: Screen all HIV-positive MSM for pre-cancerous anal cell changes, say Dutch investigators

Younger age and shorter duration of viral suppression are risk factors for the development of high-grade pre-cancerous anal lesions in HIV-positive men who have sex with men (MSM), investigators from the Netherlands report in AIDS.

They designed the study to identify demographic and HIV-related risk factors associated with the development of pre-cancerous anal lesions to target men who would benefit from high-resolution anoscopy (HRA). However, the prevalence of such lesions was so high that they recommend that all MSM living with HIV should undergo HRA.

“Of five demographic and seven HIV-related potential risk factors, only increasing age and living with suppressed viral load were significantly protective against HSIL [high-grade squamous intraepithelial lesions] vs. no SIL [squamous intraepithelial lesions],” write the authors. “Sensitivity analyses, including duration of cART [combination antiretroviral therapy] use instead of viral suppression, showed similar results.”

HIV-positive MSM have an increased risk of developing anal cancer. Many treatment centres have established clinics to detect pre-cancerous lesions. An HRA-guided biopsy is considered the gold standard for the diagnosis of these lesions. However, HRA is uncomfortable and costly. It would, therefore, be beneficial to identify the risk factors for pre-cancerous anal lesions so that HRA screening can be appropriately targeted.

Investigators at three clinics in Amsterdam, therefore, designed a study involving 1678 HIV-positive MSM who underwent HRA between 2008 and 2015 (HRA screening was offered to all HIV-positive MSM attedning these clinics). The researchers conducted a series of analyses to see if specific demographic and HIV-related factors were associated with an increased risk of lesions, including HSIL. Read more via AIDSmap