Colon

Screening colonoscopy for the detection of neoplastic lesions in asymptomatic HIV-infected subjects

E J Bini^1,2, B Green², M A Poles^1,2

¹ Division of Gastroenterology, VA New York Harbor Healthcare System, New York, USA
² Department of Medicine, New York University School of Medicine, New York, USA

Dr E J Bini, Division of Gastroenterology (111D), VA New York Harbor Healthcare System, 423 East 23^rd Street, New York, NY 10010, USA; Edmund.Bini{at}med.va.gov

Background: Although non-AIDS defining malignancies are rapidly increasing as HIV-infected subjects live longer, little is know about the results of screening for colonic neoplasms (adenomatous polyps and adenocarcinomas) in this population.

Methods: We conducted a screening colonoscopy study to determine the prevalence of colonic neoplasms in 136 asymptomatic HIV-infected subjects 50 years of age and 272 asymptomatic uninfected control subjects matched for age, sex, and family history of colorectal cancer. Advanced neoplasms were defined as adenomas 10 mm or any adenoma, regardless of size, with villous histology, high-grade dysplasia, or adenocarcinoma.

Results: The prevalence of neoplastic lesions was significantly higher in HIV-infected subjects than in control subjects (62.5% vs 41.2%, p<0.001), and remained highly significant after adjustment for potential confounding variables (odds ratio = 3.00; 95% confidence interval, 1.83 to 4.93). Among patients with colorectal adenocarcinoma, HIV-infected subjects were significantly younger (52.4 (SD 1.3) vs 60.3 (SD 4.0) years, p = 0.002) and were more likely to have advanced cancers (stage III or IV) than control subjects (60.0% vs 16.7%, p = 0.24). Of HIV-infected subjects with advanced neoplasms proximal to the splenic flexure, distal neoplastic lesions were absent in 88.9% of individuals and these would have been missed by flexible sigmoidoscopy.

Conclusions: HIV-infected subjects have a higher prevalence of colonic neoplasms, and adenocarcinomas develop at a younger age and are more advanced than in uninfected subjects. Our findings suggest that screening colonoscopy should be offered to HIV-infected subjects, but the age of initiation and the optimal frequency of screening require further study.

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