Disparities in the Clinical Evolution of Anal Neoplasia in an HIV-Infected Cohort.

Abstract

A recent meta-analysis suggested that anal intraepithelial neoplasia and invasive anal cancer are more prevalent among black men having sex with men (MSM). 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. Among 2804 patients with a median age of 40years, 78% were MSM and 38% non-white. There were no disparities in HSIL prevalence (14%) by age, sex, race, or risk group. After 4.0years 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. Black race was not associated with prevalent anal intraepithelial neoplasia nor with post-baseline progression of anal intraepithelial neoplasia.