by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

May 21, 2024

Featured Literature:

Hernandez AL, Hilton JF, Scott C, et al. Prevalence of anal HPV infection and anal HSIL among MSM 50 years and older living with or without HIV. JAIDS. 2024 May 2. doi: 10.1097/QAI. 000000000003450.   

This report provides baseline data from the Anal HPV, HIV, and Aging (AHHA) Study evaluating the prevalence and incidence of anal HPV infection and anal HSIL in a cohort of men who have sex with men ≥ 50 years of age with and without HIV. Participants completed a behavioral health questionnaire and underwent collection of anal swabs for cytology and HPV DNA genotyping, and DARE. HRA with guided biopsy of visible lesions was also performed. 238 participants were enrolled (129 living with HIV and 101 not living with HIV); 54% were ages 50-59, 36% were 60-69, and 10% were 70+ years of age. Most participants with HIV had an undetectable HIV viral load at enrollment (median CD4 was 585 cells/mm3). MSM living with HIV had a significantly higher prevalence of any oncogenic anal HPV infection compared with MSM not living with HIV (70.9% vs. 57%). Overall, prevalence of biopsy-confirmed anal HSIL was 42.6%; after accounting for HIV status and CD4, HSIL prevalence did not differ significantly between MSM with and without HIV. Multivariate analyses indicated that HPV-16 (and other oncogenic HPV infection) was associated with increased odds of prevalent anal HSIL. Increasing age was not associated with prevalent HSIL, HPV-16, or other oncogenic HPV infections.

Author’s Commentary:

Consensus guidelines from the International Anal Neoplasia Society were released earlier this year, recommending commencement of anal cancer screening at 35 years of age for MSM and transgender women with HIV (and 45 years of age for MSM and transwomen not living with HIV). These results from the AHHA study, which was unique in that it specifically enrolled participants ≥ 50 years of age (both with and without HIV), reaffirm the high prevalence of anal HSIL in these populations. The number of people eligible for anal cancer screening is likely to increase in the future. Therefore, it is critical that access to timely follow-up evaluation by experienced providers not continue to be a barrier to offering equitable cancer prevention and treatment interventions.

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