By Ed Susman, Contributing Writer, MedPage Today
Published: October 25, 2011

BOSTON — Anal intraepithelial neoplasia seems to develop during in the first year of HIV infection, according to the results of a cross-sectional study.

Among 82 patients in the study group, 32.4% were diagnosed with high-grade anal intraepithelial neoplasia and 35.4% were diagnosed with low-grade disease, said John Lough, a medical student at Rush Memorial College in Chicago, in his presentation at the annual meeting of the Infectious Diseases Society of America. In addition, 3.7% were observed with atypia and 18% of the group had normal pathology.

Action Points  

• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Explain that anal intraepithelial neoplasia seems to develop during the first year of HIV infection, according to the results of a cross-sectional study.
• Note that individuals who had more than one unprotected receptive anal sex partner during the past six months had a 4.53-fold increased risk of developing high-grade anal intraepithelial neoplasia.

“Intervention with early treatment and possibly vaccination may be able to prevent the future development of anal cancer in this high-risk population,” Lough said. He noted that high-grade anal intraepithelial neoplasia is considered a direct precursor of anal cancer.
Lough and colleagues recruited the 82 men (average age 36 years) from the Options Project, an NIH study of individuals with confirmed, primary HIV infection within the previous year. Nearly 70% of the patients in the cohort were white and about 16% were Hispanic.
About 32% of the men admitted to use of drugs, such as amphetamines, while 30% were tobacco smokers at the time of the study. Additionally, 40% of the patients were on highly active antiretroviral therapy. The median CD4-positive cell count was about 550 cells/mm3.
The patients underwent a comprehensive clinical examination, an external visual examination, and biopsies of visible anal lesions with high-resolution anoscopy. The researchers used logistic regression to find risk factors for the development of high-grade anal intraepithelial neoplasia.
The authors found that patients who had been infected with HIV for longer than six months had 5.91-fold risk of developing high-grade anal intraepithelial neoplasia when compared with patients who had been diagnosed for less than six months (P=0.01).
He said that 22% of the patients diagnosed with HIV infection for less than six months tested positive for high-grade anal intraepithelial neoplasia compared with 51.6% of patients who had been infected for more than six months (P<0.01).
Individuals who had more than one unprotected receptive anal sex partner during the past six months had a 4.53-fold increased risk of developing high-grade anal intraepithelial neoplasia (P=0.06).
“High-grade anal intraepithelial neoplasia likely develops in the later part of early HIV infection,” Lough suggested. He said that CD4-positive cells counts were not particularly helpful in determining the lesion grade.
“There is a need to continue to build capacity for screening for anal cancer especially among HIV-infected men who have sex with men,” Lough concluded.
Screening patients for anal intraepithelial neoplasia is controversial, commented IDSA session moderator Joel Gallant, MD, from Johns Hopkins University in Baltimore.
“Many of us assume we should be screening for this because of what we know about cervical cancer which is such a similar disease,” he told MedPage Today. “We extrapolate from cervical cancer that we should be doing this screening.”
But there is currently no evidence that screening can help prevent anal cancer, Gallant said, pointing out that some professional guidelines recommend it while others do not. One problem with anal cancer screening is that high-resolution anoscopy requires special training and equipment that may not be widely available, he added.

Primary source: Infectious Diseases Society of America
Source reference:
Lough J, et al “Prevalence of high-grade anal intraepithelial neoplasia increases further in early HIV infection” IDSA 2011; Abstract 1391.