Progression of anal high‐grade squamous intraepithelial lesions to invasive anal cancer among HIV‐infected men who have sex with men

PURPOSE Anal cancer risk is substantially higher among HIV-infected men who have sex with men (MSM) as compared with other reproductive-age adults, but screening is rare across sub-Saharan Africa. We report the use of high-resolution anoscopy (HRA) as a first-line screening tool and the resulting early outcomes among MSM in Abuja, Nigeria. METHODS From August 2016 to August 2017, 424 MSM enrolled in an anal cancer screening substudy of TRUST/RV368, a combined HIV prevention and treatment cohort. HRA-directed biopsies were diagnosed by histology, and ablative treatment was offered for high-grade squamous intraepithelial lesions (HSIL). HRA proficiency was assessed by evaluating the detection of squamous intraepithelial lesions (SIL) over time and the proportion biopsied. Prevalence estimates of low-grade squamous intraepithelial lesions and HSIL with 95% CIs were calculated. Multinomial logistic regression was used to identify those at the highest risk of SIL. RESULTS Median age was 25 years (interquartile range [IQR], 22-29), median time since sexual debut was 8 years (IQR, 4-12), and 59% (95% CI, 54.2% to 63.6%) were HIV infected. Rate of detection of any SIL stabilized after 200 screenings, and less than 20% had two or more biopsies. Preliminary prevalence estimates of low-grade squamous intraepithelial lesions and HSIL were 50.0% (95% CI, 44.7% to 55.3%) and 6.3% (95% CI, 4.0% to 9.3%). HIV infection, at least 8 years since anal coital debut, concurrency, and external warts were independently statistically associated with SIL. CONCLUSION Proficiency with HRA increased with experience over time. However, HSIL detection rates were low, potentially affected by obstructed views from internal warts and low biopsy rates, highlighting the need for ongoing evaluation and mentoring to validate this finding. HRA is a feasible first-line screening tool at an MSM-friendly health care facility. Years since anal coital debut and external warts could prioritize screening.

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Argon plasma coagulation treatment of anal high-grade squamous intraepithelial lesions in men who have sex with men living with HIV: results of a 2-year prospective pilot study

HIV Medicine ◽

10.1111/hiv.12544 ◽

2017 ◽

Vol 19 (2) ◽

pp. 81-89

Author(s):

A de Pokomandy ◽

D Rouleau ◽

R Lalonde ◽

C Beauvais ◽

C de Castro ◽

...

Keyword(s):

Pilot Study ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

High Grade ◽

Squamous Intraepithelial Lesions ◽

Plasma Coagulation ◽

Prospective Pilot Study ◽

Sex With Men ◽

Living With Hiv ◽

Intraepithelial Lesions

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Prevalence of Abnormal Anal Cytology and High-Grade Squamous Intraepithelial Lesions Among a Cohort of HIV-Infected Men Who Have Sex With Men

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000000095 ◽

2014 ◽

Vol 57 (4) ◽

pp. 475-481 ◽

Cited By ~ 19

Author(s):

Elena Sendagorta ◽

Pedro Herranz ◽

Hector Guadalajara ◽

Jose Ignacio Bernardino ◽

Jose María Viguer ◽

...

Keyword(s):

High Grade ◽

Squamous Intraepithelial Lesions ◽

Anal Cytology ◽

Sex With Men ◽

Intraepithelial Lesions

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18. Topical 5% 5-flourouracil (t5FU) for treatment of diffuse anal high-grade squamous intraepithelial lesions (aHSIL)

Sexual Health ◽

10.1071/shv10n6ab18 ◽

2013 ◽

Vol 10 (6) ◽

pp. 578

Author(s):

Naomi Jay ◽

J. Michael Berry ◽

Tara Walhart ◽

Teresa Darragh

Keyword(s):

Side Effects ◽

Partial Response ◽

Clinical Improvement ◽

Anal Cancer ◽

Complete Response ◽

High Grade ◽

Squamous Intraepithelial Lesions ◽

Ablative Therapy ◽

Intraepithelial Lesions ◽

Female Genital

Background Treatment of anal high-grade squamous intraepithelial lesions (aHSIL) may prevent anal cancer. Options for treatment of diffuse lesions include staged ablation, often requiring surgery, although in-office treatment is preferable. Topical 5% 5-fluorouracil (t5FU) has been used to treat diffuse female genital HPV-associated disease. We report our experience using t5FU for treatment of diffuse aHSIL considered unsuitable for ablation, to evaluate its tolerability and efficacy. Methods: Patients were given t5FU for treatment of diffuse aHSIL in doses of 0.5 mL self-applied 2× daily for 5 days followed by 9 days off. Patients were assessed on average following 4–8 cycles for complete response (CR), defined as the absence of HSIL on exam, cytology and/or histology, or partial response (PR), defined as a reduction in the amount of disease. Patients with PR then received ablative therapy. Results: 73 patients (55 HIV infected, 18 uninfected) were treated, including 13 women and 60 men. In 69 patients who used t5FU for at least one cycle, CR occurred in 8 (~11%) patients, 53 (~77%) had a partial response indicating reduction of disease, 6 (9%) had no response, and 1 had more widespread disease, 1 chart was not evaluable. Treatment was discontinued after <1 cycle in 4 patients due to side effects. Patients with PR were treated successfully with in-office ablation, except 2 patients referred for surgery. Conclusions: t5FU was well tolerated although side effects occur. Most patients had clinical improvement, suggesting that t5FU may play an important role in aHSIL treatment. Further studies may determine its optimal use.

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32. HPV type and strain variant concordance between anal cancers and their preceding high-grade squamous intraepithelial lesions

Sexual Health ◽

10.1071/shv10n6ab32 ◽

2013 ◽

Vol 10 (6) ◽

pp. 585

Author(s):

Joel Palefsky ◽

Maria Da Costa ◽

Teresa M. Darragh ◽

Naomi Jay ◽

J. Michael Berry

Keyword(s):

Anal Cancer ◽

High Grade ◽

Squamous Intraepithelial Lesions ◽

Hpv 16 ◽

Hpv Dna ◽

Formalin Fixed Paraffin ◽

Formalin Fixed Paraffin Embedded ◽

Location Methods ◽

Intraepithelial Lesions

Background Anal high-grade squamous intraepithelial lesions (HSIL) are frequently found overlying anal cancer on histology, and anal cancer has been observed to develop in the same location as previously diagnosed anal HSIL. These observations support the role of HSIL as the direct precursor lesion to anal cancer. To further investigate a direct pathogenetic relationship between anal HSIL and cancer, we typed and sequenced HPV DNA in anal HSIL and the cancers that subsequently developed in the same location. Methods: Tissues samples were analysed from 15 HIV-infected men followed at UCSF in whom anal cancer developed at a previously biopsied site of HSIL. Formalin-fixed paraffin-embedded pairs of HSIL and cancer were typed for HPV DNA using L1 PCR. HPV 16-positive samples underwent E6-based strain variant analysis. Results: Nine matched pairs for which DNA from both HSIL and cancer were available were analysed. Eight pairs (89%) contained HPV 16 DNA. One (11%) contained both HPV 18 and 51 in both samples. Of the eight HPV 16-positive pairs, each pair contained the same HPV 16 strain variant. Four contained the Eur-350T variant alone, and one contained Eur-350T in both the HSIL and cancer, with an additional 426T variant in the cancer. One pair contained both Eur-350T and 457C in both the HSIL and the cancer. Two pairs contained the Eur-350G variant alone. Conclusions: Concordance of both the HPV type and strain variant in anal cancers and their site-matched preceding HSIL further supports the role of anal HSIL as an anal cancer precursor.

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