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Multicenter Study
. 2021 Mar 1;157(3):283-289.
doi: 10.1001/jamadermatol.2020.5252.

The Risk of Anal Carcinoma After Anogenital Warts in Adults Living With HIV

Justin D Arnold  1   2 , Morgan E Byrne  3 , Anne K Monroe  3 , Stephen E Abbott  4 ; District of Columbia Cohort Executive Committee
Affiliations
Multicenter Study

The Risk of Anal Carcinoma After Anogenital Warts in Adults Living With HIV

Justin D Arnold et al. JAMA Dermatol. .

Abstract

Importance: In the US, incidence of and mortality due to anal carcinoma are rising faster than for most other cancers. Identifying populations who have a higher risk of developing anal cancers is critical to target preventive interventions.

Objective: To assess the risk of developing anal carcinoma in adults living with HIV who have a history of anogenital warts.

Design, setting, and participants: This longitudinal cohort study included adults living with HIV from 14 clinics in Washington, DC, and at least 18 months of follow-up. Data were collected from January 1, 2011, to March 31, 2017, and analyzed from June 1, 2019, to October 31, 2020.

Exposures: Development of warts in the anal or genital region identified by diagnosis codes.

Main outcomes and measures: Individuals with anal carcinoma were identified by diagnosis codes or anal biopsy results.

Results: A total of 6515 participants were enrolled (4720 male [72.4%] at birth; mean [SD] age, 49.9 [12.7] years), and 383 (5.9%) developed anogenital warts during the study period. Patients who were diagnosed with anogenital warts were more likely to subsequently develop anal carcinoma (17 of 383 [4.4%]) compared with participants without a history of anogenital warts (17 of 6132 [0.3%]) (P < .001). After adjusting for covariates, the odds of developing anal carcinoma were 12.79 (95% CI, 6.19-26.45; P < .001) times higher in individuals with a history of anogenital warts compared with individuals without a history of anogenital warts.

Conclusions and relevance: These findings suggest that adults living with HIV who have a history of anogenital warts have a substantially increased risk of developing anal carcinoma. Clinicians should counsel individuals living with HIV who have anogenital warts on this risk.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Monroe reported receiving grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Kaplan-Meier Curves and the Cox Proportional Hazards Model Ratio for Anal Carcinoma Incidence by Anogenital Wart Status
The hazard ratio (HR) is adjusted for age at enrollment, sex at birth, current or history of smoking, CD4 level nadir, years living with HIV at enrollment, HIV transmission risk factor, and the time-updated variable for anogenital warts diagnosis to account for changes in exposure over time.
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Comment in

References

    1. Lewis RM, Markowitz LE, Panicker G, Unger ER. Seroprevalence of human papillomavirus 6/11/16/18 among self-identified gay/bisexual men who have sex with men, men who have sex with women, and females, United States, 2003-2010. Clin Infect Dis. 2019;69(6):1011-1018. doi:10.1093/cid/ciy1002 - DOI - PubMed
    1. Sonnex C. Human papillomavirus infection with particular reference to genital disease. J Clin Pathol. 1998;51(9):643-648. doi:10.1136/jcp.51.9.643 - DOI - PMC - PubMed
    1. Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ. 1999;318(7188):904-908. doi:10.1136/bmj.318.7188.904 - DOI - PMC - PubMed
    1. Hoff PM, Coudry R, Moniz CM. Pathology of anal cancer. Surg Oncol Clin N Am. 2017;26(1):57-71. doi:10.1016/j.soc.2016.07.013 - DOI - PubMed
    1. Deshmukh AA, Suk R, Shiels MS, et al. . Recent trends in squamous cell carcinoma of the anus incidence and mortality in the United States, 2001-2015. J Natl Cancer Inst. 2020;112(8):829-838. doi:10.1093/jnci/djz219 - DOI - PMC - PubMed

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