Rim Sun Hee, Beer Linda, Saraiya Mona, Tie Yunfeng, Yuan Xin, Weiser John
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
J Natl Cancer Inst. 2024 Aug 1;116(8):1319-1332. doi: 10.1093/jnci/djae094.
People with HIV at highest risk of anal cancer include gay, bisexual, and other men who have sex with men and transgender women aged 35 years or older as well as other people with HIV aged 45 years or older. Identifying and treating precancerous lesions can reduce anal cancer incidence in these groups. We assessed the prevalence of anal cytology and access to high-resolution anoscopy among people with HIV overall and in those individuals at highest risk.
Data were obtained from the Centers for Disease Control and Prevention's Medical Monitoring Project, a population-based survey of people with HIV aged 18 years and older, and a supplemental Medical Monitoring Project facility survey. We report weighted percentages of people with HIV receiving anal cytology during the past 12 months, access to high-resolution anoscopy, and characteristics of HIV care facilities by availability of high-resolution anoscopy.
Overall, 4.8% (95% confidence interval [CI] = 3.4% to 6.1%) of people with HIV had undergone anal cytology in the prior 12 months. Only 7.7% (95% CI = 5.1% to 10.6%) of gay, bisexual, and other men who have sex with men as well as transgender women 35 years of age or older and 1.9% (95% CI = 0.9% to 2.9%) of all other people with HIV aged 45 years and older had anal cytology. Prevalence was statistically significantly low among people with HIV with the following characteristics: non-Hispanic or Latino, Black or African American, high school education or less, heterosexual orientation, and living in southern Medical Monitoring Project states. Among people with HIV, 32.8% (95% CI = 28.0% to 37.7%) had no access to high-resolution anoscopy on-site or through referral at their care facility; 22.2% (95% CI = 19.5% to 24.9%) had on-site access; 45.0% (95% CI = 41.5% to 48.5%) had high-resolution anoscopy available through referral. Most facilities that received Ryan White HIV/AIDS Program funding, cared for more than 1000 people with HIV, or provided on-site colposcopy also provided high-resolution anoscopy on-site or through referral.
Rates of anal cytology and access to high-resolution anoscopy were low among people with HIV, including those individuals at highest risk of anal cancer. Our data may inform large-scale implementation of anal cancer prevention efforts.
患肛门癌风险最高的艾滋病毒感染者包括男同性恋者、双性恋者和其他与男性发生性行为的男性以及35岁及以上的跨性别女性，还有45岁及以上的其他艾滋病毒感染者。识别和治疗癌前病变可降低这些人群的肛门癌发病率。我们评估了艾滋病毒感染者总体以及高危个体中肛门细胞学检查的普及率和高分辨率肛门镜检查的可及性。
数据来自疾病控制与预防中心的医疗监测项目，这是一项针对18岁及以上艾滋病毒感染者的基于人群的调查，以及一项补充的医疗监测项目机构调查。我们报告了在过去12个月接受肛门细胞学检查的艾滋病毒感染者的加权百分比、高分辨率肛门镜检查的可及性，以及按高分辨率肛门镜检查可用性划分的艾滋病毒护理机构的特征。
总体而言，4.8%（95%置信区间[CI]=3.4%至6.1%）的艾滋病毒感染者在之前12个月内接受过肛门细胞学检查。在男同性恋者、双性恋者和其他与男性发生性行为的男性以及35岁及以上的跨性别女性中，只有7.7%（95%CI=5.1%至10.6%）接受了肛门细胞学检查，而在所有45岁及以上的其他艾滋病毒感染者中这一比例为1.9%（95%CI=0.9%至2.9%）。在具有以下特征的艾滋病毒感染者中，普及率在统计学上显著较低：非西班牙裔或拉丁裔、黑人或非裔美国人、高中及以下学历、异性恋取向，以及居住在医疗监测项目南部各州。在艾滋病毒感染者中，32.8%（95%CI=28.0%至37.7%）无法在其护理机构现场或通过转诊获得高分辨率肛门镜检查；22.2%（95%CI=19.5%至24.9%）可现场获得；45.0%（95%CI=41.5%至48.5%）可通过转诊获得高分辨率肛门镜检查。大多数获得瑞安·怀特艾滋病毒/艾滋病项目资金、照顾1000多名艾滋病毒感染者或提供现场阴道镜检查的机构也在现场或通过转诊提供高分辨率肛门镜检查。
艾滋病毒感染者，包括患肛门癌风险最高的个体，肛门细胞学检查率和高分辨率肛门镜检查的可及性较低。我们的数据可为大规模开展肛门癌预防工作提供参考。
