Kevin J Blair1, Samuel Martínez-Vernaza2, Ivonne Tatiana Ordóñez-Blanco3, William Hernandez4, Camilo Quiroga3, Ellen Lowenstein2, Sandra Liliana Valderrama-Beltrán3, Jesse Clark5, Jordan E Lake6, Catherine Juillard7, Luis Jorge Lombana Amaya8. 1. South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles (UCLA), Los Angeles, California; Program for the Advancement of Surgical Equity (PASE), Department of Surgery, UCLA, Los Angeles, California. Electronic address: kevin.james.blair@gmail.com. 2. Unidad de Infectología, Departamento de Medicina Interna, Hospital Universitario San Ignacio (HUSI), Bogotá, Colombia. 3. Unidad de Infectología, Departamento de Medicina Interna, Hospital Universitario San Ignacio (HUSI), Bogotá, Colombia; Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia. 4. School of Nursing, UCLA, Los Angeles, California; DAP Health, Palm Springs, California. 5. South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles (UCLA), Los Angeles, California; Division of Infectious Diseases, Department of Medicine, UCLA, Los Angeles, California. 6. South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles (UCLA), Los Angeles, California; Department of Internal Medicine, McGovern Medical School, The University of Texas Health Sciences Center at Houston, Houston, Texas. 7. Program for the Advancement of Surgical Equity (PASE), Department of Surgery, UCLA, Los Angeles, California. 8. Unidad de Coloproctología, Departamento de Cirugía General, HUSI, Pontificia Universidad Javeriana, Bogotá, Colombia.
Abstract
BACKGROUND: Men who have sex with men (MSM) living with human immunodeficiency virus (HIV) are at increased risk of anal cancer. Anal cytology can be used to screen for dysplasia, with high-resolution anoscopy (HRA) required for diagnostic confirmation. We describe the impact lack of HRA had on management of abnormal screening results in Bogotá, Colombia. MATERIAL AND METHODS: This retrospective cohort study includes MSM with HIV who underwent anal cytology screening between January 2019February 2020, with colorectal surgery (CRS) follow-up through July 2020. Cytology results included atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL). Categorical and continuous variables were compared via Fisher's exact test and Wilcoxon rank-sum, respectively. RESULTS: Of 211 MSM screened, 68 had abnormal cytology: ASC-US (n = 23), LSIL (n = 41), HSIL (n = 4). Sixty (88.2%) were referred to CRS, and 51 (75.0%) attended ≥ 1 appointment. At initial assessment, 17 were referred for anal exam under anesthesia (EUA) for tissue resection, and 21 for rectosigmoidoscopy. Having perianal condyloma was associated with recommendation for EUA (P < 0.001), while cytology grade of dysplasia was not (P = 0.308). Eleven (16.2%) underwent EUA for condyloma resection. CONCLUSIONS: Few studies have described anal cancer screening in settings without HRA. We found lack of HRA limited management of abnormal cytology in Colombia. Those with condyloma underwent resection, but HRA remains necessary to localize and treat microscopic disease. Next steps include implementation of HRA in order to further develop the anal cancer screening program for MSM with HIV in Bogotá.
BACKGROUND: Men who have sex with men (MSM) living with human immunodeficiency virus (HIV) are at increased risk of anal cancer. Anal cytology can be used to screen for dysplasia, with high-resolution anoscopy (HRA) required for diagnostic confirmation. We describe the impact lack of HRA had on management of abnormal screening results in Bogotá, Colombia. MATERIAL AND METHODS: This retrospective cohort study includes MSM with HIV who underwent anal cytology screening between January 2019February 2020, with colorectal surgery (CRS) follow-up through July 2020. Cytology results included atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL). Categorical and continuous variables were compared via Fisher's exact test and Wilcoxon rank-sum, respectively. RESULTS: Of 211 MSM screened, 68 had abnormal cytology: ASC-US (n = 23), LSIL (n = 41), HSIL (n = 4). Sixty (88.2%) were referred to CRS, and 51 (75.0%) attended ≥ 1 appointment. At initial assessment, 17 were referred for anal exam under anesthesia (EUA) for tissue resection, and 21 for rectosigmoidoscopy. Having perianal condyloma was associated with recommendation for EUA (P < 0.001), while cytology grade of dysplasia was not (P = 0.308). Eleven (16.2%) underwent EUA for condyloma resection. CONCLUSIONS: Few studies have described anal cancer screening in settings without HRA. We found lack of HRA limited management of abnormal cytology in Colombia. Those with condyloma underwent resection, but HRA remains necessary to localize and treat microscopic disease. Next steps include implementation of HRA in order to further develop the anal cancer screening program for MSM with HIV in Bogotá.
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