Treating High-Grade Squamous Intraepithelial Lesions in HIV Prevents Anal Cancer
Douglas K. Rex, MD, MASGE, reviewing Palefsky JM, et al. N Engl J Med 2022 Jun 16.
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).
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Palefsky JM, Lee JY, Jay N, et al. Treatment of anal high-grade squamous intraepithelial lesions to prevent anal cancer. N Engl J Med 2022;386:2273-2282. (https://doi.org/10.1056/nejmoa2201048)