Lam, JO et al. Colorectal Cancer Screening in People With and Without HIV in an Integrated Health Care Setting. JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1, 2019; 81(3):284–291

Numerous observational studies have found a higher prevalence of malignancies in persons with HIV (PWH). This has raised questions regarding appropriate screening intervals for various cancers such as breast, prostate, or lung in PWH and whether screenings should be different than with the general population. This study is from the Kaiser Permanente system in Northern California, a large integrated healthcare network. The study included PWH aged 50 to 75 years and compared them with HIV-negative persons from 2005 to 2016 who had not previously undergone screening for colorectal cancer (CRC). The authors evaluated for time to initial screening by colonoscopy, sigmoidoscopy, or fecal blood test. They also assessed for the detection of CRC or adenomas by HIV status, accounting for CRC-related risk factors including sex, age, race/ethnicity, smoking, BMI, type-2 diabetes, and inflammatory bowel disease. Among PWH, they also evaluated for any association between CD4 count (<200/200–499/≥500 cells/µL) and adenoma and CRC. Among 3177 PWH and 29,219 persons without HIV, PWH were more likely to be screened (85.6% vs. 79.1%) within 5 years of study inclusion. Among those who had a colonoscopy or sigmoidoscopy, adenomas were found in approximately 20% of PWH and 23% of persons without HIV. Colon cancer was diagnosed in 0.5% of PWH and 1.0% of persons without HIV. In an adjusted analysis, there was no difference in prevalence of either adenoma or CRC by HIV status. In addition, having CD4+ count < 200 cells/mL did not increase likelihood of adenoma or colorectal cancer. The authors note in their integrated healthcare system there were no disparities in CRC screening application or outcomes among persons with and without HIV.

Author’s Commentary: This study is reassuring in several ways. First, there was not a higher incidence of colon cancer in PWH – unlike other malignancies including lymphomas and lung cancer. Second, the screening rates were actually higher for PWH compared to those without HIV disease. The current USPSTF guidelines recommend CRC screening starting at age 50 and continuing until age 75. Acceptable tests include colonoscopy every 10 years, flexible sigmoidoscopy every 5 years, fecal DNA testing every 1 to 3 years or fecal occult blood testing yearly. Periodic CRC should be part of the clinical work plan for programs providing adult HIV care.