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Colonoscopy Spots Abnormalities in
60% of German HIV Group--and Cancer in 4%
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19th Conference on Retroviruses and Opportunistic Infections, March 5-8, 2012, Seattle
Mark Mascolini
Colonoscopy revealed higher rates of "conspicuous endoscopic findings" and dysplastic mucosal tissue in 60% of HIV-positive German people who were 50 and older and agreed to undergo the procedure [1]. Four of 96 patients screened had early-stage cancer. The investigators found high acceptance of preventive colonoscopy in this HIV outpatient clinic.
Over a 12-months period in 2010-2011, clinicians in Bonn offered colonoscopy to HIV-positive people older than 50 and attending the clinic for routine care, according to recommendations for the general population in Germany. Twenty-four people declined colonoscopy, 16 asked for time to think about it, 51 had a recent colonoscopy, and 45 underwent colonoscopy. The investigators had results for all 96 people who had recent colonoscopy or agreed to colonoscopy during the study period.
Among these 96 people, 85% were men and median age was 58 years (interquartile range [IQR] 54 to 64). HIV transmission risks were sex between men in 41% and sex between men and women in 23%. Ninety-two people (96%) were taking antiretroviral therapy (ART). Median ART duration was 9 years (IQR 3 to 14), and median viral load was below 40 copies (IQR 40 to 50). Median current and nadir CD4 counts stood at 499 and 151.
Colonoscopy disclosed abnormalities in 58 people (60%), and people with abnormalities had taken antiretrovirals longer than those without abnormalities (median 10 versus 7 years, P = 0.056). The abnormal and normal groups did not differ significantly in age (median 58 in both) or in HIV transmission risk, undetectable viral load status, CD4 count (median 505 with abnormalities, 419 without), or number of colonoscopies. In the abnormal colonoscopy group, there were trends to higher rates of a family history of bowel cancer (17% versus 11%, P = 0.146) and human papillomavirus (HPV) infection (which may lead to anal cancer) (20% versus 6%, P = 0.120).
Four people (4% of the 96 screened) had early-stage carcinoma--anal cancer in 2, rectal cancer in 1, and colon cancer in 1. Histologic analysis of specimens revealed tubular adenoma in 22% of patients, hyperplastic polyps in 16%, tubulovillous adenoma in 3%, and serrated adenoma in 1%.
Univariate analysis comparing 24 people with dysplasia (abnormal cells) and 68 without dysplasia disclosed no differences in CD4 status, years of ART, undetectable viral load, number of colonoscopies, family history of colorectal cancer, personal risk factors, or hypothetically protective comedications (aspirin in 20% and statins in 15%). HCV prevalence was nonsignificantly higher in people with versus without dysplasia (29.2% versus 12.5%, P = 0.108). And a nonsignificantly higher proportion of people with dysplasia had HPV infection (20.8% versus 12.3%, P = 0.112).
The researchers proposed that the high rate of abnormalities detected and high patient willingness to undergo colonoscopy justify "intensified implementation of preventive colonoscopy in [HIV] clinical practice."
Reference
1. Boesecke C, Kasapovic A, Wasmuth JC, et al. High rates of endoscopic findings and histologic abnormalities in routine colonoscopy of HIV patients: German HIV cohort. 19th Conference on Retroviruses and Opportunistic Infections. March 5-8, 2012. Seattle. Abstract 890.
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