Abstract
Background
The aim of the present study was to evaluate patient factors that affect the progression of anal dysplasia in human immunodeficiency virus (HIV)-positive individuals.
Methods
A retrospective cohort study of HIV-positive adults with human papilloma virus related anal lesions was performed from 2012 to 2017. All patients underwent surgical excision or biopsy and fulguration of lesions in the operating room without using high resolution anoscopy. Patients with initial presentation of squamous cell carcinoma were excluded. The study was designed to investigate progression between the first available histology and either the follow up histology or a negative examination. Patient files were reviewed and data was collected. A bivariate analysis of continuous and categorical variables was performed.
Results
One hundred and sixty-one patients met the inclusion criteria. Ninety-seven percent were male. Mean age was 41 years. Thirty-five percent were African American and 47% were Caucasian. After a median follow-up interval of 331 days (IQR 120–615 days) 14 (9%) of patients had progression of disease. Visible lesions on initial presentation, as opposed to lesions found in patients undergoing examination under anesthesia because of HSIL on anal pap smear, was associated with progression (p = 0.0.2). A lower initial CD4 count (p = 0.01) and initial surgical pathology of anal condylomata (p = 0.01) were also associated with progression. High-risk serotype was associated with no change or regression (p = 0.01).
Conclusions
In our large cohort of HIV-positive patients treated without high resolution anoscopy the rate of progression was low. Most notably, visible lesions at initial presentation and CD4 count when lower were associated with progression. Initial surgical pathology of anal condylomata was associated with progression, while high-risk serotypes correlated with regression or stability. Identification of risk factors has important implications concerning postoperative surveillance and counseling of HIV-positive patients with anal condylomata/ anal dysplasia.
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05 June 2019
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Acknowledgements
This project utilized the REDCap database, which is maintained with grant support (UL1 TR000445 from NCATS/NIH). The authors wish to thank Laurie Samuels, PhD for her help with the statistical analysis. Dr. Hawkins work on this manuscript was partially supported by the National Institute of Diabetes and Digestive and Kidney Disease of the National Institutes of Health under award number K23DK118192. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding
Presented as a poster at the American Society of Colon and Rectal Surgeons, Annual Meeting, May 19–23, 2018, Nashville, TN, USA.
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This study was approved by the Vanderbilt University Medical Center IRB (Protocol 170799) with waiver of informed consent and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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Informed consent was obtained from all individual participants included in the study.
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McCutcheon, T., Hawkins, A.T., Muldoon, R.L. et al. Progression of anal intraepithelial neoplasia in HIV-positive individuals: predisposing factors. Tech Coloproctol 23, 325–332 (2019). https://doi.org/10.1007/s10151-019-01951-w
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DOI: https://doi.org/10.1007/s10151-019-01951-w