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Screening colonoscopy for the detection of neoplastic lesions in asymptomatic HIV-infected subjects
  1. E J Bini1,2,
  2. B Green2,
  3. M A Poles1,2
  1. 1
    Division of Gastroenterology, VA New York Harbor Healthcare System, New York, USA
  2. 2
    Department of Medicine, New York University School of Medicine, New York, USA
  1. Dr E J Bini, Division of Gastroenterology (111D), VA New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA; Edmund.Bini{at}med.va.gov

Abstract

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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Footnotes

  • Competing interests: None.

  • Funding: This material is based on work supported by the Office of Research and Development, Medical Research Service, the United States Department of Veterans Affairs. The United States Department of Veterans Affairs had no role in the design, conduct, or reporting of this study or in the decision to submit the manuscript for publication.

  • Ethics approval: The study protocol was reviewed and approved by the Institutional Review Board at our medical centre.

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