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

• Published in: Gut Vol. 58; no. 8; pp. 1129 - 1134
• Main Authors: Bini, E J, Green, B, Poles, M A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.08.2009; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Acquired immune deficiency syndrome; Adenocarcinoma - complications; Adenocarcinoma - diagnosis; Adenocarcinoma - pathology; Adenoma - complications; Adenoma - diagnosis; Adenoma - pathology; Age; Aged; AIDS; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Biological and medical sciences; Biopsy; CD4 Lymphocyte Count; Colonic Neoplasms - complications; Colonic Neoplasms - diagnosis; Colonic Neoplasms - pathology; Colonoscopy; Colorectal cancer; Digestive system. Abdomen; Endoscopy; Family medical history; Female; Gastroenterology. Liver. Pancreas. Abdomen; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - immunology; Human immunodeficiency virus; Human viral diseases; Humans; Infections; Infectious diseases; Investigative techniques, diagnostic techniques (general aspects); Life expectancy; Lymphocytes; Male; Mass Screening - methods; Medical sciences; Medical screening; Middle Aged; Mortality; Population; Preventive medicine; Prospective Studies; Risk Factors; Studies; Tumors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Immunopathology; AIDS; Asymptomatic; Malignant tumor; Medical screening; Immune deficiency; Infection; Viral disease; Colonoscopy; Gastroenterology; Endoscopy; Lesion; Cancer
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gut.2008.165985

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.