Treating High-Grade Squamous Intraepithelial Lesions in HIV Prevents Anal Cancer

Anal cancer is 10 times more common in HIV-positive men than cervical cancer is in women in the general population; however, women with HIV are also at increased risk of anal cancer. 

In this trial, patients diagnosed with HIV were screened for high-grade squamous intraepithelial lesions (HSILs) using high-resolution anoscopy. Biopsy-confirmed HSILs were identified in 55.1% of men, 47.2% of women, and 67.1% of transgender persons. Among the demographic characteristics of patients with HSILs who were randomized to the trial: median age of 51 years, living with HIV for a median of 17 years, 80% male gender identity, 42% Black, 77% male-to-male sexual contact, and 33% current smokers. 

Patients were randomized to active treatment of HSILs, which was mostly by office-based ablative techniques such as electrocautery (but could include excision under anesthesia or application of topical agents like fluorouracil), versus active monitoring for development of cancer. 

High-resolution endoscopy was performed at least every 6 months, and 21 cases of anal cancer developed in the active-monitoring group versus 9 in the treatment group, for a 57% reduction in risk (P=.03).