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. 2018 Feb;5(1):209-212.
doi: 10.1007/s40615-017-0358-9. Epub 2017 Mar 23.

Disparities in the Clinical Evolution of Anal Neoplasia in an HIV-Infected Cohort

Edward R Cachay  1   2 , Wollelaw Agmas  3 , Wm Christopher Mathews  3
Affiliations

Disparities in the Clinical Evolution of Anal Neoplasia in an HIV-Infected Cohort

Edward R Cachay et al. J Racial Ethn Health Disparities. 2018 Feb.

Abstract

Background: A recent meta-analysis suggested that anal intraepithelial neoplasia and invasive anal cancer are more prevalent among black men having sex with men (MSM).

Methods: We conducted a retrospective cohort of HIV-infected adult patients under care between 2001 and 2012. Disparities in clinical evolution of anal intraepithelial neoplasia to high-grade squamous intraepithelial lesion (HSIL) and invasive anal cancer were evaluated in a three-state Markov model adjusted for cytology misclassification. We studied sociodemographic covariate effects for each state transition using multivariable models controlling for antiretroviral therapy and infrared coagulation treatment of HSIL.

Results: Among 2804 patients with a median age of 40 years, 78% were MSM and 38% non-white. There were no disparities in HSIL prevalence (14%) by age, sex, race, or risk group. After 4.0 years of follow-up, 23 patients developed invasive anal cancer. Females and black patients had lower transition rates from <HSIL→HSIL (HR = 0.35 and HR = 0.55, respectively); those with age >40 had lower rates of both <HSIL→HSIL progression (HR = 0.64) and HSIL→<HSIL regression (HR = 0.56); and MSM had higher rates of progression from <HSIL→HSIL (HR = 3.30). Controlling for antiretroviral therapy and infrared coagulation (IRC) treatment as time-updated covariates, the univariable effects of sex, black race, and HIV risk factor remained significant.

Conclusions: Black race was not associated with prevalent anal intraepithelial neoplasia nor with post-baseline progression of anal intraepithelial neoplasia.

Keywords: Anal cancer; Anal intraepithelial neoplasia; Disparities; HIV; Progression; Race.

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Conflict of interest statement

Conflict of interest: None

References

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