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HIV-positive patients exhibited higher prevalence, multiplicity of colorectal polyps
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SAN DIEGO — The prevalence and multiplicity of colorectal polyps, as well as pre-malignant and advanced adenomas, was greater in HIV-positive patients than in non-infected patients, according to data presented at the 2012 Digestive Disease Week Annual Meeting.
Based on previous studies which indicated that patients with HIV and colorectal cancer exhibit more advanced disease at diagnosis, more aggressive disease, and higher mortality, researchers from the Johns Hopkins University School of Medicine conducted a single-center retrospective cohort study comparing the prevalence of colorectal neoplasia between HIV-positive and HIV-negative men and women.
“There are a number of published case studies that suggest an association between HIV infection and colorectal cancer, advanced colorectal cancer, and increased mortality compared to the non-HIV population,” Winoah A. Henry MB,BS, a gastroenterology fellow in the division of gastroenterology and hepatology at the Johns Hopkins University School of Medicine told HemOnc Today. “This is an important study because HIV infection, as we know, lowers immune defenses and may increase pre-malignant potential. There is also a hypothesis that HIV may accelerate the aging process, which is also associated with increased incidence of colorectal polyps and colorectal cancer.”
Patients with a prior history of colon cancer, inflammatory bowel disease and previous colon cancer screening within the recommended interval were excluded from the study cohort. HIV-positive patients were matched by age, sex, race, and family history to HIV-negative controls in a 1:2 ratio. The prevalence and type of colon polyps were compared between the two groups utilizing the significance test of two proportions.
“An important discovery from this study, which is quite interesting, was that sessile serrated adenomas were only seen in HIV-negative patients,” Henry said. “No sessile serrated polyps were observed in HIV-positive patients, which suggests that HIV likely exerts its effects on the traditional pathway of colorectal tumorigenesis.”
According to the study results, the prevalence of all polyps (benign, pre-malignant, and malignant) in HIV-positive compared to HIV-negative patients was 50% versus 36% (P=0.04). The percentage of patients with multiple polyps was 11.2% in patients with HIV vs. 5% in controls (P=0.08). The prevalence of pre-malignant polyps (adenomas and sessile serrated adenomas) was 28.7% in HIV-positive compared to 16.9% in controls (P= 0.03). The prevalence of advanced adenomas (adenomas with villous features, high-grade dysplasia, and >1cm) was 10% in patients with HIV and 3.1% in controls (P=0.03).
“An additional finding from this study was the mean age of patients with advanced adenomas was observed to be 53.6 years in the HIV positive group vs. 57.3 years in the HIV-negative group,” Henry said. “Patients in the HIV-positive group were found to have advanced colorectal neoplasia at a younger age, which of course, begs the question: should HIV-positive patients be targeted for earlier colorectal cancer screening? Based on this study, the guidelines should consider screening HIV-positive patients starting around age 43 to 45 years based on the evidence that we have presented here.”
Disclosure: The researchers report no relevant financial disclosures.
For more information:
- Henry WA. #Su1822: Colorectal Neoplasia in HIV-Positive Patients: a Clinical Cohort Study. Presented at: the 2012 Digestive Disease Week Annual Meeting; May 19-22, 2012; San Diego.