AI Article Synopsis
- - Anal cancer risk is significantly higher in HIV-infected men who have sex with men (MSM) in sub-Saharan Africa, but screening is not common; a study tested high-resolution anoscopy (HRA) as a first-line screening tool in Abuja, Nigeria. - During a year-long study involving 424 MSM, findings showed that after 200 screenings, the detection rate of squamous intraepithelial lesions (SIL) stabilized, with 50% prevalence of low-grade and 6.3% of high-grade lesions, while various risk factors were identified. - While HRA's effectiveness improved with experience, low detection rates of high-grade lesions were observed, possibly due to visibility issues and low biopsy rates, suggesting a need
Article Abstract
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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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690628 | PMC |
| http://dx.doi.org/10.1200/JGO.19.00102 | DOI Listing |
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