Objective: HIV-infected women and men and transplant recipients are two populations at increased risk of HPV-associated anal cancer but there is little published data. We determined anal cancer incidence and high-grade anal cytologic abnormalities (HSIL), and assessed factors associated with HSIL following organ transplantation in HIV-infected patients.

Methods: We followed 111 HIV-infected women and men who underwent liver (66%) and kidney (34%) transplantation at 6 academic centers in the U.S. During baseline (pre-transplantation) and follow-up visits post transplantation, we obtained anal cytology, demographics, and measured CD4+ T cells and HIV-1 plasma RNA.

Results: At the baseline visit prior to receiving organ transplantation, 87% were male, 50% were men who had sex with men (MSM), median age was 49 (IQR 43-54), median CD4+ T cells was 371 (IQR, 252-571), and median HIV-1 plasma RNA was <50 copies/ml. Following transplantation, the incidence of anal cancer was 170 per 100,000 person-years. Of those with no disease at baseline, 9%, 19% and 22% were found to have HSIL at 6, 12 and 24 months post transplantation. In multivariable analyses, there was evidence for the association of nadir CD4 at enrollment (HR 1.3, 95% CI 1.03-1.6) and MSM behavior (HR 7.9, 95% CI, 1.0-64) with incident HSIL.

Conclusions: There is a high incidence of anal cancer and AIN among HIV-infected patients following transplantation. This is especially true since anal cytology underestimates the occurrence of AIN. Further studies will determine the optimal periodicity and timing of anal cancer screening among transplant recipients.

CITATION INFORMATION: Chin-Hong P., Barin B., Berry M., DaCosta M., Darragh T., Rosenthal L., Bartlett S., Dieterich D., Poordad F., Nissen N., Wong M., Stock P., Palefsky J. Organ Transplantation Associated with High Incidence of Anal Cancer and Pre-Cancer Lesions among HIV-Infected Women and Men Am J Transplant. 2017;17 (suppl 3).

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