Colorectal Cancer Screening in People With and Without HIV in an Integrated Health Care Setting

Abstract

As people with HIV (PWH) live longer, age-appropriate colorectal cancer (CRC) screening is increasingly important. Limited data exist on CRC screening and outcomes comparing PWH and persons without HIV. Large integrated healthcare system. This study included PWH and demographically-matched persons without HIV who were aged 50-75 years during 2005 to 2016 and had no prior CRC screening. We evaluated time to first CRC screening (fecal test, sigmoidoscopy or colonoscopy). We also assessed detection of adenoma and CRC with sigmoidoscopy or colonoscopy by HIV status, accounting for CRC risk factors including sex, age, race/ethnicity, number of outpatient visits, smoking, BMI, type-2 diabetes and inflammatory bowel disease. Among PWH, we evaluated whether CD4 count (<200/200-499/≥500 cells/µl) was associated with adenoma and CRC. Among 3,177 PWH and 29,219 persons without HIV, PWH were more likely to be screened (85.6% vs. 79.1% within 5 years, p<0.001). Among those with sigmoidoscopy or colonoscopy, adenoma was detected in 161 (19.6%) PWH and 1,498 (22.6%) persons without HIV and CRC was detected in 4 (0.5%) PWH and 69 (1.0%) persons without HIV. In adjusted analyses, we found no difference in prevalence of either adenoma or CRC by HIV status (adjusted prevalence ratio=0.97, 95% CI=0.83-1.12). Lower CD4 count did not increase likelihood of adenoma or CRC. Within an integrated healthcare system with an organized CRC screening program, we found no disparities in CRC screening uptake or outcomes among people with and without HIV, and CD4 count did not influence CRC risk among PWH.