AEGiS-14IAC: Effect of HAART on incidence of anal intraepithelial neoplasia grade 3 among HIV-positive men who have sex with men.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Effect of HAART on incidence of anal intraepithelial neoplasia grade 3 among HIV-positive men who have sex with men.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. LbOr21)

Palefsky J, Holly E, Ralston M, Jay N, Berry M, Darragh T
UCSF, San Francisco, United States

BACKGROUND: HAART has led to declines in the incidence of Kaposi's sarcoma and non-Hodgkins lymphoma but its effect on HPV-associated anogenital cancers is unclear. The incidence of anal cancer is 37-fold higher among HIV+ MSM compared with the general population of men. Anal cancer most likely is preceded by anal intraepithelial neoplasia (AIN) 3. The purpose of this study was to determine the effect of HAART on the prevalence and incidence of AIN 3 among HIV+ men who have sex with men (MSM).

METHODS: Prospective cohort study of AIN among HIV+ MSM at the University of California, San Francisco. At baseline and every 6 months, a questionnaire was administered to obtain data on behavioral and medical risk factors for AIN including use of HAART. At each visit anal cytology and high-resolution anoscopy with biopsy of visible lesions were obtained. The level of AIN was classified using the more severe result of cytology and histology.

RESULTS: Of 433 HIV+ men enrolled at baseline, 15% were not on any HAART regimen. 12% were diagnosed with AIN 3 at baseline. The risk of prevalent AIN 3 was 2.6 (95% CI 1.3-5.3) for men on HAART compared with those not on HAART after adjustment for CD4+ level. Over a 24-month follow-up period 51% (95% CI 43-59) of HIV+ men on HAART developed AIN 3 compared with 37% (95% CI 25-50) of men not on HAART (p=.11)

CONCLUSION: The prevalence and incidence of AIN 3 were higher among HIV+ men on HAART compared with HIV+ men not on HAART even after adjustment for CD4+ level. HAART does not reduce the incidence of AIN 3 among HIV+ MSM. The proportion of men with AIN 3 who will progress to cancer if left untreated is unknown. AIN 3 may take several years to progress. Our data suggest that the incidence of anal cancer will continue to rise in the HAART era as men with AIN 3 live longer. Screening programs to identify and treat AIN 3 before progression to cancer should be considered for HIV+ MSM even if they are on HAART.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Anus Neoplasms, Incidence, HIV Infections, Papillomavirus, Human, Carcinoma in Situ, HIV Seropositivity, Coitus, Prevalence, Risk Factors, Cohort Studies, Anus, Prospective Studies, California, San Francisco, Human, Male, epidemiology

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