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. 2025 Feb 24;80(2):371-380.
doi: 10.1093/cid/ciae359.

Early Detection of Cancer and Precancerous Lesions in Persons With HIV Through a Comprehensive Cancer Screening Protocol

Félix Gutiérrez  1   2   3 , Leandro López  1   3 , Carlos Galera  4 , Juan Manuel Tiraboschi  5 , Joseba Portu  6 , Lucio García-Fraile  3   7 , Miguel García Del Toro  8 , Enrique Bernal  9 , Antonio Rivero  3   10 , Javier García-Abellán  1   2   3 , Juan Flores  11 , Ana González-Cordón  12 , Onofre Martínez  13 , Joaquín Bravo  14 , Dácil Rosado  15 , Marta Montero  16 , Guillem Sirera  17 , Miguel Torralba  18 , Maria José Galindo  19 , Juan Macías  3   20   21 , Inmaculada Gónzalez-Cuello  22 , Vicente Boix  23 , María Jesús Vivancos  24 , Paula Dios  25 , Jose Ramón Blanco  26 , Sergio Padilla  1   2   3 , Marta Fernández-González  1   3 , Ana Gutiérrez-Ortiz de la Tabla  27 , Esteban Martínez  3   12 , Mar Masiá  1   2   3 ; IMPAC-Neo Study Group
Collaborators, Affiliations

Early Detection of Cancer and Precancerous Lesions in Persons With HIV Through a Comprehensive Cancer Screening Protocol

Félix Gutiérrez et al. Clin Infect Dis. .

Abstract

Background: Non-AIDS defining malignancies present a growing challenge for persons with human immunodeficiency virus (HIV, PWH), yet tailored interventions for timely cancer diagnosis are lacking. The Spanish IMPAC-Neo protocol was designed to compare two comprehensive cancer screening strategies integrated into routine HIV care. This study reports baseline data on the prevalence and types of precancerous lesions and early-stage cancer among participants at enrolment. Acceptability of the procedure was additionally assessed.

Methods: Cross-sectional analysis of a comprehensive screening protocol to detect precancer and cancer. The readiness of healthcare providers to implement the protocol was evaluated using a validated 4-item survey.

Results: Among the 1430 enrolled PWH, 1172 underwent 3181 screening tests, with positive findings in 29.4% of cases, leading to further investigation in 20.7%. Adherence to the protocol was 84%, with HIV providers expressing high acceptability (97.1%), appropriateness (91.4%), and feasibility (77.1%). A total of 145 lesions were identified in 109 participants, including 60 precancerous lesions in 35 patients (3.0%), 9 early-stage cancers in 9 patients (0.8%), and 76 low-risk lesions in 65 subjects (5.5%). Adverse events related to screening occurred in 0.8% of participants, all mild. The overall prevalence of cancer precursors or early-stage cancer was 3.8% (95% confidence interval [CI], 2.74%-5.01%), with highest rates observed in individuals screened for anal and colorectal cancers.

Conclusions: The baseline comprehensive cancer screening protocol of the IMPAC-Neo study successfully identified a significant proportion of PWH with precancerous lesions and early-stage cancer. High adherence rates and positive feedback from providers suggest effective implementation potential in real-world healthcare settings.

Trial registration: ClinicalTrials.gov NCT04735445.

Keywords: HIV; cancer; early diagnosis; screening; surveillance.

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Conflict of interest statement

Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Participants undergoing anal (n = 445; panel A) and colorectal cancer screenings (n = 894; panel B) and the outcomes of the screening cascade at baseline. Abbreviations: FOBT, fecal occult blood test; HSIL, high-grade squamous intraepithelial lesion; LSIL, low-grade squamous intraepithelial lesion.
See this image and copyright information in PMC

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