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Anal Cancer Screening in HIV-Infected Patients: Is It Time to Screen Them All?
MedLine Citation:
PMID:  23135582     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: : Annual screening for anal cancer is recommended only for HIV patients at increased risk: men who have sex with men, individuals with a history of anogenital warts, and women with cervical dysplasia.
OBJECTIVE: : The aim of this study was to examine the screening outcomes between HIV populations with and without these risk factors.
METHODS: : We reviewed the records of all HIV patients referred for anal cytology and high-resolution anoscopy from June 2009 to June 2010. Patients were stratified into an increased-risk group or a standard-risk group.
MAIN OUTCOME: : Of the 329 evaluable patients, 285 (89.8% men, 10.2% women, mean age 46 ± 10 years) were classified to the increased-risk group, whereas 44 (72.7% men, 27.3% women, mean age 52 ± 8 years) were included in the standard-risk group. Male sex, white race, sexual orientation, past and current receptive anal intercourse, noncompliance with condom use, and absence of a new sexual partner were significantly different in the increased-risk group in comparison with the standard-risk group. In the increased-risk group, 187 (66.5%) patients had biopsy-proven dysplasia of which 118 (42.0%) had high-grade disease. In the standard-risk group, 15 (34.9%) patients had biopsy-proven dysplasia of which 7 (16.3%) had high-grade disease. Cytology detected biopsy-confirmed high-grade dysplasia only in 23 of 118 (19.5%) patients in the increased-risk group and in 2 of 7 (28.6%) patients in the standard-risk group. Kappa agreement in detecting high-grade disease was low for both increased-risk and standard-risk groups: 0.16 (95% CI 0.07-0.23) and 0.40 (95% CI 0.02-0.40).
LIMITATIONS: : Our study is a chart-based retrospective review of data with a small female population. Histology reports came from 2 different laboratories.
CONCLUSION: : High-grade anal dysplasia was prevalent even among HIV patients who only have standard risk factors. Anal cytology and high-resolution anoscopy have poor agreement. We suggest considering annual screening by using high-resolution anoscopy in addition to cytology for all HIV patients regardless of risk factors.
Alexander O Mallari; Theresa M Schwartz; Amneris E Luque; Pamela S Polashenski; Stephen M Rauh; Roberto B Corales
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-08     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1244-50     Citation Subset:  IM    
1 Department of Medicine, Rochester General Hospital, Rochester, New York 2 Anal Dysplasia Clinic, University of Rochester Medical Center, Rochester, New York 3 Infectious Diseases Division, University of Rochester Medical Center, Rochester, New York 4 Department of Surgery, University of Rochester Medical Center, Rochester, New York 5 AIDS Care, Rochester, New York.
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