Anal cancer screening results from 18-to-34-year-old men who have sex with men living with HIV

Men who have sex with men living with HIV (MSM LWH) are at highest risk for human papillomavirus (HPV)-associated anal cancer. There is no consensus on the optimal screening initiation age. This study aimed to assess the prevalence and severity of anal HPV disease among MSM LWH under the age of 35, which is a currently proposed screening age threshold. Between 2014 and 2020, 1255 18-to-34-year-old MSM LWH underwent anal cytology screening. 916 were co-tested for high-risk HPV (HR-HPV). 467 underwent high-resolution anoscopy (HRA) and biopsy. Cancer registry data were queried. Predictors of abnormal cytology (ie, & GE;ASCUS) and histological high-grade squamous intraepithelial lesions (HSIL) were evaluated using unadjusted logistic regression models. Median age was 28 years (range, 18-34). 19% received at least one dose of HPV vaccine. Abnormal cytology rate was 65%. HR-HPV and HPV16 prevalence were 87% and 30%. Biopsy results were benign (10%), LSIL (43%) and HSIL (47%). No cases of prevalent or incident anal cancers were detected. Findings were similar between age subgroups (18-24, 25-29 and 30-34) except for a higher prevalence of AIN 3 in the 30-34 group (19%). Abnormal cytology was significantly associated with HR-HPV infection. Histological HSIL was associated with HR-HPV infection and cytological LSIL or worse. The absence of anal cancer in a large cohort of MSM LWH under the age of 35, despite high prevalence of anal HR-HPV infection and precancer, supports an age-based anal cancer screening strategy for MSM LWH. Screening for anal human papillomavirus (HPV)-associated precancer among men who have sex with men living with HIV (MSM LWH) can help prevent invasive anal cancer. Debate remains, however, about the optimal age at which screening should begin. This study investigated anal (pre) cancer prevalence in MSM LWH who received anal cytology screening before age 35, with cases of abnormal cytology referred for high resolution anoscopy. The data reveal a high prevalence of anal HPV infection and precancer but no case of invasive anal cancer, even when anal precancer was not treated, supporting the adoption of age-based anal cancer screening for MSM LWH starting at age 35 when anal cancer risk begins to increse.image

Automated summary

This study investigated the prevalence and severity of anal HPV disease among MSM LWH under the age of 35, finding a high prevalence of HPV infection and precancer but no cases of invasive anal cancer. This supports the adoption of age-based anal cancer screening for this population.