Abstract 4179: Anal cancer risk factors and utilization of cancer preventive strategies in people living with HIV in Puerto Rico
Authors: Garcia-Camacho Sandra I. , Ramos-Cartagena Jeslie M. , Soto-Salgado Marievelisse , Colon-Lopez Vivian , Ortiz-Ortiz Karen J. , Deshmukh Ashish A. , Ortiz Ana P. 
Published: April 2023

Abstract
Introduction: Anal cancer (AC) risk is greatly elevated among persons living with HIV (PLWH), particularly men who have sex with men (MSM). The incidence of anal cancer among PLWH in Puerto Rico is 60.5 per 100,000 in MSM. Smoking and sexual behaviors may enhance anal cancer risk among PLWH. Therefore, we describe the prevalence of risk factors for AC, overall and by sexual risk group (MSM, women, and men who have sex with women [MSW]). We also evaluated receipt of cancer preventive strategies: HPV vaccination and AC screening, among a sample of PLWH in Puerto Rico.
Methods: A cross-sectional study was conducted (Sept 2020 - Dec 2021) among PLWH ≥26 aged in Puerto Rico (n=212). Participants answered a phone interview that collected information on relevant characteristics. AC risk factors evaluated were current smoking, age of sexual initiation (≤15 years), lifetime anal sex, 10 or more lifetime sexual partners, history of AIDS, genital warts, and HPV infection. HPV vaccination and AC screening status were also evaluated. The overall and sexual risk group specific prevalence of AC risk factors and preventive behaviors were described. In addition, the prevalence ratio (PR) of the variables of interest, comparing the sexual risk groups, was estimated with 95% confidence intervals using Poisson regression.
Results: Mean age of participants was 52.8 ± (SD=10.2); 44.1% were MSM, 23.2% were MSW, and 32.7% were women. Most PLWH had public health insurance (84.4%), an education level of high-school or less (45.7%), and 9.5% had a history of intravenous drug use. Regarding the prevalence of AC risk factors, 58.3% had 10 or more lifetime sex partners, 51% had their first sexual relationship at age ≤15 years, 29.3% were current smokers, and 75.8% of women had history of anal sex. In addition, 20.8% reported being diagnosed with AIDS, 16.5% had a history of genital warts, and 12.0% had HPV infection. Only 7.5% reported HPV vaccination and 52.2% reported ever having had an anal pap test. MSM had the highest prevalence of risky sexual behaviors, although no statistical difference was seen in the PRs. For preventive strategies, women (PR: 3.13, 95% CI 1.52-6.46) and MSM (PR: 3.42, 95% CI 1.70-6.90) had higher prevalence of anal pap uptake than MSW.
Conclusion: Persons living with HIV in Puerto Rico had high prevalence of current smoking use and risky sexual behavior. Despite their increased risk of AC, and only over half had been screened for AC. Continued education and awareness about AC risk factors, smoking cessation, and importance of prevention strategies are important among PLWH.
Citation Format: Sandra I. Garcia-Camacho, Jeslie M. Ramos-Cartagena, Marievelisse Soto-Salgado, Vivian Colon-Lopez, Karen J. Ortiz-Ortiz, Ashish A. Deshmukh, Ana P. Ortiz. Anal cancer risk factors and utilization of cancer preventive strategies in people living with HIV in Puerto Rico. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4179.