Early Detection of Cancer and Precancerous Lesions in Persons With Human Immunodeficiency Virus (HIV) Through a Comprehensive Cancer Screening Protocol

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. A comprehensive cancer screening protocol integrated into routine human immunodeficiency virus (HIV) care detected many with precursor lesions and early-stage cancers, enabling timely treatment. High adherence and positive feedback suggest strong implementation potential in real-world healthcare settings.