Impact of screening and antiretroviral therapy on anal cancer incidence in HIV-positive MSM.

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State: Public
Version: Final published version
Serval ID
serval:BIB_33A347D9C69C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Impact of screening and antiretroviral therapy on anal cancer incidence in HIV-positive MSM.
Journal
AIDS
Author(s)
Blaser N., Bertisch B., Kouyos R.D., Calmy A., Bucher H.C., Cavassini M., Estill J., Keiser O., Egger M.
Working group(s)
Swiss HIV Cohort Study
ISSN
1473-5571 (Electronic)
ISSN-L
0269-9370
Publication state
Published
Issued date
24/08/2017
Peer-reviewed
Oui
Volume
31
Number
13
Pages
1859-1866
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
The incidence of anal cancer is high in HIV-positive MSM. We modeled the impact of screening strategies and combination antiretroviral therapy (cART) coverage on anal cancer incidence in Switzerland.
Individual-based, dynamic simulation model parameterized with Swiss HIV Cohort Study and literature data. We assumed all men to be human papillomavirus infected. CD4 cell count trajectories were the main predictors of anal cancer. From 2016 we modeled cART coverage either as below 100% (corresponding to 2010-2015) or as 100%, and the following four screening strategies: no screening, yearly anal cytology (Papanicolaou smears), yearly anoscopy and targeted anoscopy 5 years after CD4 count dropped below 200 cells/μl.
Median nadir CD4 cell count of 6411 MSM increased from 229 cells/μl during 1980-1989 to 394 cells/μl during 2010-2015; cART coverage increased from 0 to 83.4%. Modeled anal cancer incidence peaked at 81.7/100 000 in 2009, plateaued 2010-2015 and will decrease to 58.7 by 2030 with stable cART coverage, and to 52.0 with 100% cART coverage. With yearly cytology, incidence declined to 38.2/100 000 by 2030, with yearly anoscopy to 32.8 and with CD4 cell count guided anoscopy to 51.3. The numbers needed to screen over 15 years to prevent one anal cancer case were 384 for yearly cytology, 313 for yearly anoscopy and 242 for CD4 cell count-dependent screening.
Yearly screening of HIV-positive MSM may reduce anal cancer incidence substantially, with a number needed to screen that is comparable with other screening interventions to prevent cancer.

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Web of science
Create date
07/08/2017 9:55
Last modification date
20/08/2019 14:19
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