Sa1515 Should We Keep HIV Infected Patients in the Average-Risk Screening Category? a Sub-Analysis of the Comp (Colonoscopy Outcomes in Minority Population) Registry Data

Abstract

Should We Keep HIV Infected Patients in the Average-Risk Screening Category? a Sub-Analysis of the Comp (Colonoscopy Outcomes in Minority Population) Registry Data Manhal Olaywi*, Shashideep Singhal, Kinesh Changela, Deepanshu Jain, Devin Lane, Mojdeh Momeni, Mahesh Krishnaiah, Sushil Duddempudi, Sury Anand Gastorenterology, The Brooklyn Hospital Center, Brooklyn, NY Introduction: Human Immunodeficiency Virus (HIV) infected patients have altered immune system and host defenses that affect their predisposition to cancers. There is limited literature to elucidate the effect of HIV on colorectal carcinogenesis and precancerous colonic adenomas. The analysis was targeted to determine the differences in development of colonic adenomas in HIV infected subjects in comparison to general population. Methods: The subjects with HIV were selected from the COMP registry at our institution using ICD 9 code. Subjects presenting for screening colonoscopy age 50 to 75 years were included, while colonoscopies done for evaluation of symptoms or surveillance of prior malignancy were excluded. The demographic, clinical, and pathological data of study subjects were analyzed using SPSS statistical software to compare HIV positive and control group. Results: A total of 1775 colonoscopies met the inclusion criteria with 115 subjects who were identified as HIV positive and 1660 in control group. Racial distribution was African Americans 58%, Hispanics 32% and 10% others. There was a predominance of males in the HIV group 60% in comparison to control group 40% (p 0.01). There were no other significant differences in demographics of HIV group in comparison to controls. A significantly higher proportion of HIV patients had poor bowel preparation 14.8% in comparison to control group 9.5% (p 0.05), hence were excluded from the analysis to exclude the confounding effect. The adenoma detection rate (ADR) for the HIV group 13% was lower 13% in comparison to the controls 23.6% (P 0.001). The advanced adenoma detection rate (AaDR) was also lower in the HIV group 7.8%, while it was 14% in the control group (P 0.03). On a multivariate analysis HIV positivity was independently associated with lower ADR and AaDR. Conclusion: In our study, the prevalence of pre-malignant colonic adenomas and advanced adenomas in HIV-infected patients was lower than the HIV negative patients. These data support the current practice of screening HIV-infected according to the average-risk screening guidelines.