Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
Department of Medicine, University of California, San Francisco, CA, USA.
J Natl Cancer Inst. 2024 Jan 10;116(1):97-104. doi: 10.1093/jnci/djad176.
Anal intraepithelial neoplasia grade III is a precursor to squamous cell carcinoma of the anus for which rates are nearly 20-fold higher in people with HIV than in the general population in the United States. We describe trends in anal intraepithelial neoplasia grade III diagnosis and risk of squamous cell carcinoma of the anus following anal intraepithelial neoplasia grade III by HIV status and sex.
We used data from a population-based linkage between cancer and HIV registries in 11 US states; Puerto Rico; and Washington, DC, during 1996-2019. We identified all individuals with a diagnosis of anal intraepithelial neoplasia grade III and determined their HIV status. We estimated the average annual percentage change of anal intraepithelial neoplasia grade III using Poisson regression stratified by HIV status and sex. We estimated the 5-year cumulative incidence of squamous cell carcinoma of the anus following an anal intraepithelial neoplasia grade III diagnosis stratified by sex, HIV status, and prior AIDS diagnosis.
Among people with HIV, average annual percentage changes for anal intraepithelial neoplasia grade III were 15% (95% confidence interval [CI] = 12% to 17%) per year among females and 12% (95% CI = 11% to 14%) among males. Average annual percentage changes for those without HIV were 8% (95% CI = 7% to 8%) for females and 8% (95% CI = 6% to 9%) for males. Among people with HIV, a prior AIDS diagnosis was associated with a 2.7-fold (95% CI = 2.23 to 3.40) and 1.9-fold (95% CI = 1.72 to 2.02) increased risk of anal intraepithelial neoplasia grade III diagnosis for females and males, respectively. Five-year cumulative incidence of squamous cell carcinoma of the anus following anal intraepithelial neoplasia grade III for people with HIV with a prior AIDS diagnosis were 3.4% and 3.7% for females and males, respectively.
Rates of anal intraepithelial neoplasia grade III diagnoses have increased since 1996, particularly for people with HIV, likely influenced by increased screening. A prior AIDS diagnosis was strongly associated with risk of anal intraepithelial neoplasia grade III diagnosis.
三级肛门上皮内瘤变是肛门鳞状细胞癌的前体，在美国，艾滋病毒感染者的发病率比普通人群高近 20 倍。我们描述了按 HIV 状况和性别分层的三级肛门上皮内瘤变诊断和三级肛门上皮内瘤变后肛门鳞状细胞癌风险的趋势。
我们使用了 1996 年至 2019 年间美国 11 个州、波多黎各和美属维尔京群岛以及华盛顿特区癌症和艾滋病毒登记处之间的人群基础链接的数据。我们确定了所有三级肛门上皮内瘤变诊断患者的 HIV 状况。我们使用泊松回归，按 HIV 状况和性别分层，估计三级肛门上皮内瘤变的平均年百分比变化。我们按性别、HIV 状况和既往 AIDS 诊断分层，估计三级肛门上皮内瘤变诊断后 5 年肛门鳞状细胞癌累积发生率。
在 HIV 感染者中，女性每年的三级肛门上皮内瘤变平均百分比变化为 15%（95%置信区间 [CI] = 12%至 17%），男性为 12%（95% CI = 11%至 14%）。未感染 HIV 的人群中，女性为 8%（95% CI = 7%至 8%），男性为 8%（95% CI = 6%至 9%）。在 HIV 感染者中，既往 AIDS 诊断与女性和男性的三级肛门上皮内瘤变诊断风险分别增加 2.7 倍（95% CI = 2.23 至 3.40）和 1.9 倍（95% CI = 1.72 至 2.02）相关。既往 AIDS 诊断的 HIV 感染者三级肛门上皮内瘤变后 5 年肛门鳞状细胞癌累积发生率分别为女性 3.4%和男性 3.7%。
自 1996 年以来，三级肛门上皮内瘤变的诊断率有所上升，尤其是在 HIV 感染者中，这可能与筛查的增加有关。既往 AIDS 诊断与三级肛门上皮内瘤变诊断风险密切相关。
