Early Detection of Cancer and Precancerous Lesions in Persons With HIV Through a Comprehensive Cancer Screening Protocol
Authors: Gutiérrez Félix , López Leandro , Galera Carlos , Tiraboschi Juan Manuel , Portu Joseba , García-Fraile Lucio , García del Toro Miguel , Bernal Enrique , Rivero Antonio , García-Abellán Javier , Flores Juan , González-Cordón Ana , Martínez Onofre , Bravo Joaquín , Rosado Dácil , Montero Marta , Sirera Guillem , Torralba Miguel , Galindo Maria José , Macías Juan , Gónzalez-Cuello Inmaculada , Boix Vicente , Vivancos María Jesús , Dios Paula , Blanco Jose Ramón , Padilla Sergio , Fernández-González Marta , Gutiérrez-Ortiz de la Tabla Ana , Martínez Esteban , Masiá Mar ,   IMPAC-Neo Study Group, Gutiérrez Félix , Masiá Mar , Padilla Sergio , García-Abellán Javier , Botella Ángela , Mascarell Paula , Fernández-González Marta , García Jose Alberto , Ledesma Christian , López Leandro , Vallejo Jennifer , Robledano Catalina , Adsuar Araceli , Galera Carlos , Iglesias Helena Albendin , Navarro Antonia Castillo , Lopez Marian Fernandez , Merlos Maria Angustias , Tiraboschi Juan Manuel , Klug Ana Carina Silva , Mor Alícia Sedo , Quilen Carlos Alberto González , Piatti Camila Soledad , González Sandra Morenilla , Portu Joseba , de Adana Ester Sáez , Muñiz Irene San Jose , Arana Juan Carlos Gainzarain , García-Fraile Lucio , de los Santos Ignacio , Hernández Susana , Gutiérrez Belén , Bermúdez Ana , Casen Andoni , del Toro Miguel García , Muñoz Neus Gómez , de la Torre Marta Plaza , de Medrano Vicente Abril López , Belda José Emilio Ballester , Rodríguez Magdalena García , Salcedo Johana Isadora Gutiérrez , González José Ignacio Mateo , Olmos Carmen Ricart , Bernal Enrique , Cano Alfredo , Muñoz Ángeles , Alcaraz Antonia , Alcaraz Mª José , Villalba Mª Carmen , Rivero Antonio , Mata Díana Corona , Gallo Marina , Valero Ignacio Pérez , Flores Juan , González-Cordón Ana , Martínez Esteban , Inciarte Alexy , Martínez Onofre , García Josefina , Vera Francisco , Alcáraz Begoña , Sánchez Antonio , Martínez Lorena , Bravo Joaquín , Martínez Isabel Carpen , Garrido Rosa Mª Blazquez , Guirao Antonio Sánchez , Cascón Ana Martín , Martínez Mónica Martínez , Belando Sergio Alemán , Rosado Dácil , García Nereyda Tosco , Hernández María Jehovana , Montero Marta , Pitarch Mariona Tasias , Muñoz Eva Calabuig , Lletí Miguel Salavert , Sirera Guillem , Nieto Aroa , Novas Melani , Torralba Miguel , Galindo Pepa , Gómez Sandra Pérez , Macías Juan , Rincón Pilar , Pino María Inmaculada , Llenas-García Jara , López Belén Martínez , González-Cuello Inmaculada , López María García , Boix Vicente , Rodríguez Gema García , Esquerdo Verónica Pérez , Estévez Ángela María Rubio , Vivancos María Jesús , del Campo Terrón Santos , Pons Mario , de las Heras Daniel , Dios Paula , Mostaza José Luis , Guerra José , Blanco José Ramón , Barrio María , Pérez Reyes Pascual , Nieto Mónica Romero , Wikman Philip 
Published: July 2024

Abstract

Background
Non-AIDS defining malignancies present a growing challenge for persons with human immunodeficiency virus (HIV, PWH), yet tailored interventions for timely cancer diagnosis are lacking. The Spanish IMPAC-Neo protocol was designed to compare two comprehensive cancer screening strategies integrated into routine HIV care. This study reports baseline data on the prevalence and types of precancerous lesions and early-stage cancer among participants at enrolment. Acceptability of the procedure was additionally assessed.

Methods
Cross-sectional analysis of a comprehensive screening protocol to detect precancer and cancer. The readiness of healthcare providers to implement the protocol was evaluated using a validated 4-item survey.

Results
Among the 1430 enrolled PWH, 1172 underwent 3181 screening tests, with positive findings in 29.4% of cases, leading to further investigation in 20.7%. Adherence to the protocol was 84%, with HIV providers expressing high acceptability (97.1%), appropriateness (91.4%), and feasibility (77.1%). A total of 145 lesions were identified in 109 participants, including 60 precancerous lesions in 35 patients (3.0%), 9 early-stage cancers in 9 patients (0.8%), and 76 low-risk lesions in 65 subjects (5.5%). Adverse events related to screening occurred in 0.8% of participants, all mild. The overall prevalence of cancer precursors or early-stage cancer was 3.8% (95% confidence interval [CI], 2.74%–5.01%), with highest rates observed in individuals screened for anal and colorectal cancers.

Conclusions
The baseline comprehensive cancer screening protocol of the IMPAC-Neo study successfully identified a significant proportion of PWH with precancerous lesions and early-stage cancer. High adherence rates and positive feedback from providers suggest effective implementation potential in real-world healthcare settings.