Study ANRS EP 57 – APACHES : towards an evidence base for the prevention of anal cancer.

Background to the study

Persons living with HIV, particularly men having sex with men, have a high burden of HPV-related anal cancer. At the time of initiation of this study, although screening for anal cancer in persons living with HIV (PLHIV) had been proposed, using cytological, virological or other biomarkers to detect and treat the presumed anal cancer precursor, anal intraepithelial neoplasia (AIN)2/3. However, little was known about the natural history of anal HPV infection and AIN2/3, nor the efficiency of algorithms for anal cancer screening.

Main objective

To characterise the natural history of anal HPV infection and related lesions among HIV-infected homosexual men aged 35 years across France.

Results of the APACHES study

513 participants were recruited between 2 December 2014 and 30 June 2022 in six recruitment centres located in France (Paris, Marseille, Rennes, Lyon, Montpellier, Dijon).

Scientific publications of the APACHES study

• Findings from baseline visits:

1. Determinants of high-grade anal intraepithelial lesions in HIV-positive MSM. Clifford GM et al, AIDS. 2018
2. Prevalence and Risk Factors for Anal Human Papillomavirus Infection in Human Immunodeficiency Virus-Positive Men Who Have Sex with Men. Combes JD et al, J Infect Dis. 2018

• Findings from 2 year follow-up :

1. Incidence and Clearance of Anal Human Papillomavirus (HPV)-16 and HPV-18 Infection, and Their Determinants, Among Human Immunodeficiency Virus-Infected Men Who Have Sex With Men in France. Alberts CJ, J Infect Dis. 2020
2. Cumulative Detection of Anal High-Grade Squamous Intraepithelial Lesions Over 2-Year Follow-up in Men Who Have Sex With Men Living With Human Immunodeficiency Virus in France. Combes JD et al. J Infect Dis. 2024

• Preliminary findings from 5-year follow-up of anal HSIL

1. Persistence and Clearance of Histological Anal High-Grade lesions in Men who have sex with men living with HIV. Clifford GM et al. Abstract. International Papillomavirus Conference. Edinburgh. 2024. (Article devant être soumis prochainement pour publication)

• CoContribution of baseline data to larger pooled analyses

1. Incidence and Clearance of Anal Human Papillomavirus Infection in 16 164 Individuals, According to Human Immunodeficiency Virus Status, Sex, and Male Sexuality: An International Pooled Analysis of 34 Longitudinal Studies. Wei F, et al. Clin Infect Dis. 2023
2. Epidemiology of anal human papillomavirus infection and high-grade squamous intraepithelial lesions in 29 900 men according to HIV status, sexuality, and age: a collaborative pooled analysis of 64 studies. Wei F et al Lancet HIV. 2021
3. A systematic review and meta-analysis of cytology and HPV-related biomarkers for anal cancer screening among different risk groups. Clarke MA, Int J Cancer. 2022

Guidelines

Since publication of APACHES findings, first French recommendations for anal screening have been published (Spindler L, Société Nationale Française de Colo-Proctologie, Tech Coloproctol. 2024), including for persons living with HIV

Recommandations de dépistage et prise en charge des cancers chez les personnes vivant avec le VIH, des hépatites virales et des IST : rapport d’experts