Colorectal Cancer Screening in HIV-Positive Patients in a Major U.S. Metropolitan Hospital

Abstract

Purpose: Since the introduction of highly active antiretroviral therapy (HAART), patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are living longer. This increased life expectancy has implications for the long term care of these patients, including appropriate screening for non-AIDS defining cancers, such as colorectal cancer (CRC). Current guidelines recommend CRC screening starting at age 50 for all patients at average risk for CRC. Most studies suggest the risk of CRC is not increased in HIV infected patients and this population may not be receiving adequate screening for CRC. We designed a study to determine whether or not HIV- infected patients are being screened sufficiently for CRC and to examine the incidence of polyps and colorectal cancer in these patients. Methods: We conducted a retrospective review of all lower endoscopies performed on HIV-positive patients for any indication between January 2001 and October 2005 in Grady Memorial Hospital. For each HIV-infected patient we identified one age- and gender-matched control subject without HIV who underwent lower endoscopy during the same period. Results: Between January 2001 and October 2005, 302 HIV-positive patients underwent lower endoscopic procedures. Of these, 112 were over the age of 50, including 78 males and 34 females with average ages of 59 ± 8.6 and 52 ± 6.3, respectively. The proportion of HIV-infected patients who underwent lower endoscopy for screening purposes was significantly lower than in control subjects (21% vs 41%, p < 0.001). Of the HIV-positive patients who underwent screening lower endoscopy, 6 tubular adenomas (TA), 3 hyperplastic polyps (HP), and 1 tubulovillous adenoma (TVA) were identified. The average CD4 count of those patients with polyps was 396 vs 480 for those without polyps. Conclusions: HIV-infected patients were significantly less likely to undergo lower endoscopy for screening purposes than controls, suggesting that these patients are not being adequately screened for CRC. Additionally, the incidence and proportion of various types of polyps appears similar in HIV patients to that reported in the literature for the general population. Finally, the observed association between low CD4 counts and the presence of polyps needs to be verified as we continue to expand our sample size.