Impact of screening programme to prevent anal cancer in high‐risk patients with HIV

Abstract

AbstractIntroductionWe assessed the impact of a nationwide screening programme to reduce the risk of anal cancer in a large cohort of high‐risk patients with HIV.MethodsFrom a large database from one referral centre, all high‐risk patients with HIV (men who have sex with men, history of anal or genital warts, or previous cervix human papillomavirus‐related lesions) who were eligible to enter the French anal cancer screening programme (2011–2020) were retrospectively included. Adherence to the screening programme was defined as no interval >18 months between two visits. Standardized management included perianal visualization and standard anoscopy with biopsies of macroscopic abnormalities.ResultsOverall, 700 patients with HIV were included (median follow‐up 8.4 years [interquartile range 4.3–9.2] and 1491.6 patient‐years), and 336 had one or more proctology visit. A total of 13 patients were diagnosed with anal squamous cell carcinomas. The risk of anal cancer was higher with anal intra‐epithelial neoplasia grade 3 (AIN3; hazard ratio [HR] 44.5 [95% confidence interval {CI} 11.2–176.6], p < 0.001), AIN2 (HR 11.9 [95% CI 2.1–66.9], p = 0.005), or high‐grade dysplasia (HR 23.4 [95% CI 7.9–69.1], p < 0.001) than with low‐grade dysplasia or no lesion. Among the patients who were strictly adherent to the screening programme (4.6% [32/700]), we did not report any AIN or anal cancer, but we also did not observe any significant reduction in the risk of anal cancer (p = 0.51), AIN3 (p = 0.28), high‐grade dysplasia (p = 0.19), or any AIN lesions (p = 0.10) compared with non‐adherent patients. In contrast, screened patients were more likely to be diagnosed with anal warts (HR 3.71 [95% CI 2.14–6.42], p < 0.001).ConclusionMacroscopic high‐grade dysplasia lesions are associated with a higher risk of developing anal cancer. Despite finding no cases of cancer during the screening programme, we also did not demonstrate a clear benefit from our screening programme for the prevention of anal cancer in high‐risk patients with HIV.