The New England Journal of Medicine publishes findings.
Michael Hagensee, MD, Ph.D., and his team of researchers have demonstrated for the first time that treating precancerous anal growths known as high-grade squamous intraepithelial lesions (HSILs) in people living with HIV dramatically reduced the progression to anal cancer.
Human papillomavirus (HPV), which also causes cervical cancer, causes precancerous high-grade squamous intraepithelial lesions that have the potential to develop into anal cancer.
“Treatment of high-grade cervical lesions is known to prevent cervical cancer in women,” notes Dr. Hagensee. “Anal cancer has Increased 25-fold in persons living with HIV, and the ANCHOR study is based on the same approach.”
At 25 sites across the US, more than 4,000 HIV-positive individuals with high-grade anal lesions on biopsy were enrolled in the ANCHOR (Anal Cancer-HSIL Outcomes Research) experiment.
“We screened over 300 people at University Medical Center and followed 100 with high-grade lesions,” says Dr. Hagensee, who sees patients at UMC, a major LSU Health New Orleans teaching hospital.
Participants were randomised to either a group receiving treatment or one that received the current standard of care, which included close observation. Those in the therapy group underwent methods to eliminate the lesions, including topical fluorouracil or imiquimod injection, office-based ablative techniques, ablation, or excision under anaesthesia.
A treatment decreased anal cancer by 57%. Although anal cancer is uncommon in the general population, the prevalence has been rising in the US, with 9,440 new cases expected in 2022. The group at greatest risk are those with HIV.
“Our results support the use of screening and treatment for anal HSIL as the standard of care for persons living with HIV,” Dr. Hagensee concludes. “Next steps include determining the best way to screen persons living with HIV for detecting high-grade lesions, when should this screening start and at what intervals, and what is the best way to treat someone with high-grade anal lesions.”