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Session: ePoster: Other Neoplasia and Endoscopy 6 (Mon115)

EP802 - Low-Grade Squamous Intraepithelial Lesions of the Anal Canal: Comparing Rates of Progression by HIV Status

Monday, May 12, 2025
1:36 PM – 1:41 PM PT

    ePoster Presenter(s)

  • Julia S. Rhie-Lee, BS (she/her/hers)

    Research Fellow
    Icahn School of Medicine at Mount Sinai
    New York, NY, United States

    Disclosure information not submitted.

    • Author(s)

  • Hannah Williams, MD

    Resident
    Icahn School of Medicine at Mount Sinai
    Memorial Sloan Kettering Cancer Center
    New York, New York, United States

    Disclosure information not submitted.

    • Author(s)

  • HH

    Hans M. Huber, MD, MPH

    Resident
    Icahn School of Medicine at Mount Sinai
    New York, New York, United States

    Disclosure information not submitted.

  • AN

    Ahmad Nasasra, MD

    Resident
    Icahn School of Medicine at Mount Sinai
    New York, New York, United States

    Disclosure information not submitted.

  • AB

    Alexander Bulanov, DO

    Assistant Professor of Surgery
    Icahn School of Medicine at Mount Sinai
    New York, New York, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • SK

    Sanghyun A. Kim, MD

    Associate Professor of Surgery
    Icahn School of Medicine at Mount Sinai
    New York, New York, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Hannah Williams, MD: This individual has no financial relationships with ineligible companies.
Alexander Bulanov, DO: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: The progression rate from low-grade (LSIL) to high-grade (HSIL) squamous intraepithelial lesions of the anal canal remains poorly described. Immunocompromised patients with HIV may be particularly high-risk for progression. However, there is a paucity of data on optimal surveillance intervals, testing strategies and long-term follow-up in patients with an LSIL diagnosis. This retrospective cohort study of LSIL patients aims to compare rates of HSIL progression by HIV status.

Methods/Interventions: This was a retrospective cohort study of a prospectively maintained database of 1010 patients at a single-institution between 2010 and 2024. Patients were excluded if they had a previous diagnosis of HSIL or anal squamous cell carcinoma. Patients with an LSIL diagnosis by pap-smear or biopsy during high-resolution anoscopy (HRA) were included if they had more than one year of follow-up data available. Pap-smear and/or HRA were performed at 12-month intervals. The primary outcome of interest was progression to HSIL. Univariable Cox proportional hazards models were used to analyze associations between baseline characteristics and progression to HSIL.

Results/Outcomes: Of the 78 patients available for analysis, 56 (71.8%) were HIV-positive. The median time from LSIL diagnosis to HSIL progression or last known follow-up was 2.3 (IQR 2.8) years. The majority of patients still had LSIL at the end of follow-up (n=41, 52.6%), while 17 (21.8%) had LSIL clearance and 20 (25.6%) had progression to HSIL. HIV-positive patients were more likely to have HSIL progression compared to HIV-negative patients (32.1% vs. 9.1%; p=0.045). There were no significant predictors of progression to HSIL on univariable cox-regression analysis.

Conclusion/Discussion: This study demonstrated that HIV-positive patients have a higher incidence of progression to HSIL. While our results were likely underpowered to detect significant differences on survival analyses, our findings suggest that immunocompromised patients require close surveillance after diagnosis of LSIL. Larger studies are needed to determine whether providers can safely extend surveillance intervals in immunocompetent patients given their lower risk of progression.