25. Observational database of anal dysplasia in persons living with HIV/AIDS (PLWH) in an HMO

Abstract

Background: PLWH have increased risk for HPV-related squamous cell cancer of the anus. Screening PLWH for anal dysplasia can reduce morbidity and mortality. Routine screening for anal dysplasia is not yet universally adopted. Accumulating evidence and clinical experience support screening for and treatment of precancerous lesions. Methods: KPNW started an anal dysplasia screening program using anal cytology, HRA with biopsies and ablation of biopsy-proven HGAIN as a routine component of the primary care HIV services. The Anal Dysplasia Clinic (ADC) follows and treats members with any abnormal findings. Treatment includes the use of intra-anal imiquimod, trichloroacetic acid, efudex and infrared coagulation. When indicated, patients are referred to rectal surgery for excision and fulguration. Results: 73% of eligible members have been screened for anal dysplasia. 45% of the 1438 screenings performed were abnormal. There have been 390 referrals since 20 April 2011. To evaluate the success of early detection and treatment, stages of precancerous lesions found in each biopsy are tracked. 619 biopsies were examined from 207 patients. There has been an overall decrease in HGAIN in patients who received multiple biopsies. 52% of 122 patients with HGAIN were successfully treated with IRC. Conclusions: Over 300 patients have been identified as having anal abnormalities. Routine anal Pap screening is easily performed in an HMO setting utilising clinic support staff. High-grade lesions were present in 70% and correlated with Pap smear but not CD4 nadir. Routine anal Pap smears in PLWH followed by HRA with biopsy and treatment HGAIN should be the standard of care for PLWH.