Half of HIV-positive gay or bisexual men successfully treated for anal lesions (tissue damage) that can lead to cancer had the same kind of lesions within 24 months, according to results of a recent study. The findings underline the importance of close follow-up and monitoring with your doctor after treatment of precancerous anal lesions.
Gay or bisexual men with HIV run a higher risk of anal precancer and anal cancer itself than the general population, which highlights the importance of getting regular screenings. The precancer called high-grade anal intraepithelial neoplasia (HGAIN) may lead directly to anal cancer and affects 30% of HIV-positive gay or bisexual men.
Researchers conducted this study (1) to identify risk factors for recurrent HGAIN after successful treatment in gay or bisexual men with HIV and (2) to compare different strategies for monitoring such men for repeat HGAIN.
The study involved 100 HIV-positive men in whom examination of anal tissue samples confirmed successful treatment of HGAIN. Every three to six months, these men made follow-up visits to undergo three tests: (1) anal cell studies to look for precancer changes, (2) blood sample analysis to look for human papillomavirus (HPV), a virus that can lead to HGAIN and (3) high-resolution anoscopy (HRA), a procedure that allows health workers to look inside the anus. Men with findings suggesting new HGAIN had another biopsy so technicians could examine anal tissue samples.
After an average of 17.6 months of follow-up, HGAIN recurred in 39% of men who had been successfully treated before. The researchers estimated a HGAIN recurrence rate of 23.5% in the 12 months after initially successful therapy and a 53.5% recurrence rate in 24 months. Anal cancer did not develop in any man during the study.
The researchers linked four factors to a higher risk of recurrent HGAIN:
- A positive antibody test for hepatitis C virus raised the risk 2.8 times.
- A lowest-ever CD4 count below 200 boosted the risk 2.6 times.
- A previous large HGAIN raised the risk 8.3 times.
- Having at least two cancer-causing HPV types raised the risk 2.3 times.
Comparing HRA, anal cell studies and detection of cancer-causing HPV types, the researchers found that HRA offers the best chance of detecting recurrent HGAIN after previous successful treatment.
The researchers concluded that HIV-positive men run a high risk of recurrent HGAIN after successful treatment of previous HGAIN. Because of this high recurrence rate, the authors stressed that "regular posttreatment follow-up visits are mandatory." And their findings indicated that "HRA appears to be the best follow-up strategy."
For gay and bisexual men living with HIV, the takeaway message is to get regular screenings for anal precancer and cancer and to continue to get screened, even after successful treatment, to make sure the precancer doesn't recur.