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High uptake of yearly digital rectal exam for anal cancer in Australian MSM with HIV
 
 
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22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018
 
Mark Mascolini
 
Almost three quarters of 327 Melbourne men who have sex with men (MSM) with HIV had 3 of 3 annual digital rectal exams as an early check for anal cancer [1]. Adverse events were rare and specialist referral rates matched those for other cancer screening programs.
 
MSM with HIV run a high risk of anal cancer, which often gets diagnosed in harder-to-treat late stages. Cell-based screening for cervical cancer, another malignancy caused by human papillomavirus, has proved effective in preventing that cancer in women. But a similar screening protocol for anal cancer remains unproved. A simple screening strategy for anal care, regular digital rectal exams, could be a straightforward way to prevent some anal cancers in MSM with and without HIV.
 
To test uptake of yearly digital anal rectal exams (DARE) and outcomes, in 2014 Australian investigators recruited 327 MSM with HIV and at least 35 years old from a major sexual health clinic, two high-caseload HIV practices, and one tertiary-care hospital in Melbourne. Healthcare professionals recommended that the men undergo DARE at baseline and 1 and 2 years later.
 
Participating men averaged 51 years in age (standard deviation +/-9), 69% were born in Australia, 32% currently smoked, and CD4 count averaged 630. Among 327 men studied, 232 (71%) had all 3 DAREs, 71 (22%) had 2, and 24 (7%) had 1. Rare adverse events included anal pain (in 1.2% of all DAREs), bleeding (0.8%), and not feeling in control of one's body during the exam (1.6%).
 
Thirty-three of 862 DAREs (3.8%) led to referrals to a colorectal surgeon. Among 327 baseline DAREs, 74% found no abnormality, 21% found an abnormality but did not lead to referral, and 5% found an abnormality and led to referral. Among 268 year-1 DAREs, respective proportions were 80%, 19%, and 1%. And for 267 year-2 DAREs, proportions were 78%, 17%, and 5%. DAREs detected 1 stage 1 anal cancer and 8 stage 2/3 anal intraepithelial lesions. The procedures also uncovered 31 skin tags, 31 anal warts, and 22 hemorrhoids.
 
Among 241 men who completed a final questionnaire, 229 (95%) said they would continue to have annual DARE and 190 (79%) claimed they would now be more likely to consult a clinician if they found an abnormality or had anal symptoms.
 
"Integrating an early cancer detection program into routine HIV clinical care is feasible," the researchers concluded, "particularly in settings where anal cytology and high-resolution anoscopy services are unavailable."
 
Reference
 
1. Ong JJ, Walker S, Grulich A, et al. Early detection of anal cancer in men who have sex with men (MSM) living with HIV by incorporating digital anorectal examinations (DARE) into routine HIV care: A prospective cohort study. AIDS 2018: 22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018. Abstract TUPEB083. https://programme.aids2018.org//PAGMaterial/eposters/4109.pdf
 

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Early detection of anal cancer in men who have sex with men living with HIV by incorporating digital ano-rectal examinations (DARE) into routine HIV care: a prospective cohort study
 
Jason J. Ong1-3, Sandra Walker3, Andrew Grulich4, Jennifer Hoy5, Tim R.H. Read1,3, Catriona Bradshaw1,3, Marcus Chen1,3, Suzanne M. Garland6, Richard Hillman7, David J. Templeton4,8, Jane Hocking9, Beng Eu10, BK Tee11, Eric P.F. Chow1,3, Christopher K. Fairley1,3 1 Central Clinical School, Monash University, Australia; 2 London School of Hygiene and Tropical Medicine, United Kingdom; 3 Melbourne Sexual Health Centre, Alfred Health, Australia; 4 Kirby Institute, University of New South Wales, Australia; 5 Department of Infectious Diseases, Alfred Health, Australia; 6 Department of Obstetrics and Gynaecology, University of Melbourne, Department of Microbiology in Infectious Diseases, Royal Women's Hospital, Murdoch Children's Research Institute, Parkville, Australia; 7 HIV, Immunology and Infectious Disease, St Vincent's Hospital, Darlinghurst, Australia; 8 RPA Sexual Health, Sydney Local Health District and Sydney Medical Medical School, The University of Sydney, Australia; 9 Melbourne School of Population and Global Health, University of Melbourne, Parkville Australia; 10 Prahran Market Clinic, Prahran, Australia; 11 The Centre Clinic, Victorian AIDS Council, St Kil

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