CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

760

Evaluation of the Performance of Different High-Resolution Anoscopy Triage Strategies in MSM LWH Eugenio Nelson Cavallari 1 , Federica Alessi 1 , Chiara Eberspacher 1 , Marco Ridolfi 1 , Ilyass El Abboubi 2 , Alessandra Latini 3 , Angelina Pernazza 1 , Daniela Bosco 2 , Domenico Mascagni 2 , Claudio Maria Mastroianni 2 , Gabriella D'Ettorre 2 1 Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy, 2 Sapienza University of Rome, Rome, Italy, 3 San Gallicano Dermatology Institute, Rome, Italy Background: Treatment of anal high grade squamous intraepithelial lesions (HSIL) have been proved to be effective in reducing the incidence of squamous cell carcinoma of the anus (SCCA) in men who have sex with men (MSM) living with HIV (LWH). High resolution anoscopy (HRA) is the gold standard for detection of anal HSIL. Access to HRA is still not widely available due to the small number of trained providers. Definition of triage pathways to better allocate HRA resources is crucial to implement SCCA screening programs for PLW. Methods: To evaluate sensitivity (SE) and specificity (SP) of different HRA triage strategies, we retrospectively analyzed data from 180 MSM LWH that underwent SCCA screening with HRA directed biopsies and for whom anal cytology and anal HPV DNA collected on the same day of HRA were available. In the analysis, only HRA that led to the identification of HSIL were classified as positive. As hypothetic threshold for referral to HRA we tested: 1) cytology of atypical squamous cells of undetermined significance (ASCUS) or worse; 2) cytology of low grade squamous intraepithelial lesion (LSIL) or worse; 3) cytology of atypical squamous cells cannot exclude HSIL (ASC-H) or worse; 4) any high risk HPV genotype (HR-HPV); 5) HPV16; 6) ASCUS or worse + HR-HPV; 7) LSIL or worse + HR-HPV; 8) ASCUS or worse + HPV16. Results: When considering cytology criteria as tirage to HRA: an ASCUS threshold would have triggered 125 HRA (SE 70.9%; SP 32.4%); an LSIL threshold would have triggered 107 HRA (SE 62%; SP 43.1%); an ASC-H threshold would have led to 10 HRA (SE 11.4%; SP 99%). When considering anal HPV infection as triage for HRA: a threshold of any HR-HPV would have triggered 105 HRA (SE 84.8%; SP 62.7%), while a threshold of anal infection with HPV16 would have led to 57 HRA (SE 50.6%%; SP 83.3%). When considering a composite triage: a threshold of ASCUS or worse + HR-HPV would have led to 81 HRA (SE 64.6%; SP 70.6%); a threshold of LSIL or worse + HR-HPV would have triggered 65 HRA (SE 54.4%%; SP 78.4%); a threshold of ASCUS or worse + HPV16 would have triggered 43 HRA (SE 38%; SP 87.3%). Conclusion: Triage to HRA with the identification of anal HR-HPV infection offered the best balance between sensibility and specificity. The association of anal cytology (ASCUS or worse, or LSIL or worse) and HR-HPV, which present lower sensibility and higher specificity, seem feasible given the periodic nature of such screening. Official approval of assays for the diagnosis of anal HR-HPV is needed. Anal Self-Sampling Is Suitable for Anal Cancer Screening Among Men Who Have Sex With Men in Togo Valentine M. Ferré 1 , Arnold Sadio 2 , Romane Guilbaud 1 , Meryem Zaidi 3 , Mawussé K. Attiso 4 , Mounerou Salou 5 , Laurent Abramowitz 1 , Mélanie Bertine 1 , Amivi P. Amenyah-Ehlan 5 , Ephram Mensah 4 , Claver Anoumou Dagnra 5 , Jade Ghosn 1 , Diane Descamps 1 , Didier Koumavi Ekouevi 2 , Charlotte Charpentier 1 1 Université Paris Cité, Paris, France, 2 Centre Africain de Recherche en Épidémiologie et en Santé Publique, Lomé, Togo, 3 Assistance Publique–Hôpitaux de Paris, Paris, France, 4 NGO Espoir Vie Togo, Lomé, Togo, 5 L'Université de Lomé, Lomé, Togo Background: Anal cancer screening guidelines exist only locally or nationally for some at-risk population like MSM living with HIV. In sub-Saharan Africa, there is no access to anal cytology analysis and proctologic consultations. There is a need to implement HPV detection strategy to screen most at-risk patients. The aim of this study was to evaluate anal self-sampling (ASS) for HPV detection compared to anal swab carried out by the practitioner (ASP). Methods: The ANRS 12400 DepIST-H cohort included 200 MSM in Togo, half living with HIV, prospectively followed up with yearly anal sampling and proctologic exam. During the month-12 visit, ASS was proposed to MSM before clinical consultation. A flyer explaining the procedure accompanied the FloqSwab for ASS, which was discharged into eNAT. The practitioner conducted afterwards anal exam, anal sampling with a cytobrush discharged in ThinPrep. All samples were analyzed by the Virology lab of Bichat Hospital (Paris, France) with AnyplexII for detection of 14 high-risk HPV (HR-HPV). HPV16 viral load was quantified with in-house qPCR. Results: A total of 188 MSM were included, median age of 23 years, 99% of participants found the ASS procedure was easy to carry out and 60% of

them would prefer ASS to ASP at next visit while 19% had no preference. ASS was suitable for HPV detection since only 5% samples were uninterpretable compared to 7% for ASP (p=0,77). Overall, at least one HR-HPV was detected in 83% (n=148/178) and 77% (n=135/176) of ASP and ASS, respectively, and 28% and 26% were positive for HPV16. ASP and ASS showed substantial agreement (89.7%) for HR-HPV detection with Kappa's coefficient of 0.66). The agreement for HPV16 was 90.3% (Kappa's coefficient = 0.75). HPV16 median viral loads were higher in ASS than ASP (7652c/mL vs 575c/mL respectively, p=0.009). Regarding the 16 samples with discordant result for HPV16 detection, HPV16 viral load was low (160c/mL for ASS and 155c/mL for ASP in median). Conclusion: To our knowledge, this is the first time ASS and ASP are compared for HPV detection performance at the same time. The concordance of the two sampling methods, the acceptability of ASS and the facility to implement self sampling are in favor of using ASS for HPV detection in anal cancer screening programs. The HPV detection implementation worldwide for cervical cancer screening following the WHO's 2020 guideline will enable anal cancer screening implementation in LMIC. The figure, table, or graphic for this abstract has been removed. Long-Term ART Is Not Associated With Reduced Anogenital Cancer Risk: A Case-Cohort Study Maanasa Mendu 1 , Taolo Ntloedibe 2 , Memory Bvochora-Nsingo 3 , Sebathu Chiyapo 3 , Kutlo Manyake 2 , Isaac Nkele 2 , Rebecca Luckett 4 , Tendani Gaolathe 2 , Joseph M. Makhema 2 , Peter Vuylsteke 5 , Shahin Lockman 2 , Scott Dryden Peterson 2 1 Harvard University, Cambridge, MA, USA, 2 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 3 Life Gaborone Private Hospital, Gaborone, Botswana, 4 Beth Israel Deaconess Medical Center, Boston, MA, USA, 5 University of Botswana, Gaborone, Botswana Background: People with HIV (PWH) are at increased risk of anogenital cancer. Malignancies of the cervix, vulva, anus, and penis have become leading causes of morbidity and death for PWH globally. HIV-related immune dysfunction may contribute to excess risk. We sought to assess whether sustained antiretroviral treatment (ART) reduces excess risk of anogenital cancer in PWH. Methods: We conducted a case-cohort study in Botswana involving citizens aged 20 to 65. Adults with anogenital cancer were prospectively enrolled in a cancer cohort ("Thabatse") from 2012-2020 at the 4 principal cancer treatment centers in Botswana. The subcohort was drawn from the Ya Tsie trial, which included a random 20% household sample of 30 communities (2013-2015) and an 80% sample in 6 communities (2017) in Botswana. ART duration was divided into three categories: No ART, ART < 5 years, and ART ≥ 5 years. We estimated the marginal relative risk (compared to HIV-uninfected) of incident anogenital cancer by ART duration using G-computation with inverse probability of treatment weights (IPTW), accounting for common factors of HPV and HIV, ART duration, and access to cancer treatment: 5-year age strata, education, age at first intercourse, smoking status, geographic region, and time period. Results: A total of 17,321 participants were enrolled, including 1,377 cancer cases. HIV prevalence was higher in individuals with cancer (80%) than persons without cancer (30%). PWH who received longer duration ART (≥ 5 years) were older than PWH who received shorter duration ART (< 5 years) (median age 44 and 38, respectively). Proportions of PWH on ART with CD4 nadir greater than 350 cells/µL were 55% and 58%, respectively. Greater than 95% of participants on ART had HIV virologic suppression. Following IPTW, the analytic cohort was balanced with standardized mean difference (SMD) <0.05 for included factors, and parameters of access to cancer treatment were similar across groups (SMD <0.15). In all categories of ART duration, HIV-infection was associated with a large increase in risk for each cancer studied. Compared with shorter duration, longer duration ART was associated with greater risk of anogenital cancers: anus RR 1.86 (95% CI 1.2, 2.8); vulva RR 1.83 (95% CI 1.4, 2.5); penis RR 2.58, (95% CI 1.8, 3.7); cervix RR 1.12, (95% CI 1.0, 1.3, non-significant). Conclusion: Prolonged ART does not reduce age-standardized anogenital cancer risk. Further interventions are needed to address excess cancer risk in PWH on ART. The figure, table, or graphic for this abstract has been removed.

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Poster Abstracts

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CROI 2024 227