CROI 2014: Natural History of HIV-Related Anal Dysplasia [VIDEO]


The progression of anal dysplasia is highly variable in people with HIV, progressing in some and remaining stable or regressing in others, according to a retrospective analysis of nearly 3000 participants presented at the 21st Conference on Retroviruses and Opportunistic Infections (CROI 2014) last week in Boston. Progression to invasive anal cancer, however, was uncommon.

[Wollelaw Agmas, CROI press conference, March 6, 2014]

Wollelaw Agmasfrom the University of California at San Diego and colleagues followed more than 2800 HIV positive people between 2003 and 2012, looking at changes in Pap smear cytology results over time. Most participants were men, the median age was about 40 years, the median CD4 T-cell count was approximately 380 cells/mm3, and three-quarters were taking antiretroviral therapy.

The researchers found that progression from high-grade anal neoplasia to invasive anal cancer was rare, occurring in 2.2%. At the same time, a large proportion of participants experienced neoplasia regression or improvement (up to about 60%, depending on assumptions about test accuracy).

Given these findings, Agmas suggested, "it may be reasonable to defer immediate treatment" in favor of watchful waiting, assuming regular follow-up is assured.



WW Agmas, ER Cachay, C Jackson, et al. Natural History of HIV-Related Anal Dysplasia: A Multi-State Modeling Analysis. 21st Conference on Retroviruses and Opportunistic Infections (CROI 2014). Boston, March 3-6. Abstract 720.