Treating Anal HSIL Cuts Anal Cancer Risk in Persons With HIV

THURSDAY, June 16, 2022 — Among persons living with HIV who have anal high-grade squamous intraepithelial lesions (HSILs), those who receive treatment have a lower rate of progression to anal cancer than those who receive active monitoring without treatment, according to a study published in the June 16 issue of the New England Journal of Medicine.

Joel M. Palefsky, M.D., from the University of California in San Francisco, and colleagues conducted a phase 3 trial at 25 U.S. sites involving persons living with HIV aged 35 years or older with biopsy-proven anal HSIL who were randomly assigned to receive HSIL treatment or active monitoring without treatment. Treatment included office-based ablative procedures, ablation or excision under anesthesia, or administration of topical fluorouracil or imiquimod.

Overall, 4,446 patients were included in the analysis of the time to progression to cancer. The researchers found that nine cases were diagnosed in the treatment group compared with 21 in the active-monitoring group (173 and 402 per 100,000 person-years, respectively), with a median follow-up of 25.8 months. Compared with the active monitoring group, the treatment group had a 57 percent lower rate of progression to anal cancer.

“Our data provide support for the use of screening and treatment for anal HSIL as the standard of care for persons living with HIV who are 35 years of age or older,” the authors write. “Our data may also be relevant for other groups at increased risk for anal cancer.”

In-kind support was provided by Hologic (ThinPrep vials) and Bausch Health (fluorouracil cream).

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