Edward R Cachay1,2, Wollelaw Agmas3, Wm Christopher Mathews3. 1. Department of Medicine, Owen Clinic. UC San Diego, San Diego, CA, USA. ecachay@ucsd.edu. 2. Division of Infectious Diseases, UC San Diego, San Diego, CA, USA. ecachay@ucsd.edu. 3. Department of Medicine, Owen Clinic. UC San Diego, San Diego, CA, USA.
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.
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.
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