A Study of Anal Cancer Development in HIV Infected People

Study Description

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

The purpose of this study is to compare the development of abnormal cell growth or cancer in the anal region of individuals who are receiving one of two different anti-HIV treatment strategies.

Condition or disease
HIV Infections; Anus Neoplasms

Detailed Description:

Human papillomavirus (HPV) is a common viral infection among men and women. Individuals with HPV are at risk for anal dysplasia, a condition that may lead to anal cancer. It has been observed that HIV progresses more rapidly in individuals coinfected with HPV and HIV, compared to people with either disease alone. Studies that have investigated the effect of highly active antiretroviral therapy (HAART) on the progression of anal dysplasia have been contradictory and inconclusive. The role of CD4 count and HIV suppression and their contributions to the progression of anal disease needs to be determined. This trial is a substudy of a study of management of antiretroviral therapy (SMART). In the SMART study, patients will participate in one of two strategies: a drug conservation (DC) strategy and a viral suppression (VS) strategy. Participants in the DC group will stop or defer HAART, then receive episodic HAART treatment for the minimum time needed to maintain a CD4 cell count of at least 250 cells/mm3. Participants in the VS group will receive HAART to maintain a viral load as low as possible, regardless of CD4 count. This study will compare the times to development of high-grade anal dysplasia or anal cancer in participants who are currently enrolled in the SMART study.

Patients will participate in this substudy and the main SMART study at the same time. At the baseline visit, participants will undergo an anal swab; some female participants will have a cervical swab as well. Participants will provide a detailed sexual history including sexually transmitted infections, a history of anal-related conditions, and a history of alcohol and recreational drug use. These procedures will be repeated at each annual follow-up visit. Some participants may undergo additional anal cytology and high-resolution anoscopy with biopsy. Participants will be followed until they develop high-grade anal dysplasia or anal cancer or when the SMART study closes, whichever comes first.

Study Design

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Study Type :	Observational
Enrollment :	560 participants
Time Perspective:	Prospective
Official Title:	Anal Dysplasia: A Substudy of a Large, Simple Trial Comparing Two Strategies for Management of Anti-Retroviral Therapy (The SMART Study)
Study Start Date :	February 2005
Actual Primary Completion Date :	March 2006
Actual Study Completion Date :	March 2006

Groups and Cohorts

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Outcome Measures

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Primary Outcome Measures :

1. Time to high-grade anal dysplasia or anal cancer

Secondary Outcome Measures :

1. Time to anal cancer
2. time to low-grade or high-grade anal dysplasia
3. time to anal HPV infection
4. time to anal HPV infection with a specific strain, for types 16, 18, or 31
5. time to cervical HPV infection
6. time to cervical HPV infection with a specific strain, for types 16, 18, or 31
7. time to high-grade anal dysplasia
8. time from low-grade anal dysplasia to normal

Eligibility Criteria

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Ages Eligible for Study:	13 Years and older (Child, Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Coenrollment in the SMART study
• Normal anal cytology result. If baseline anal cytology is abnormal, high-resolution anoscopy must be performed and specimens must be obtained.
• Parent or guardian willing to provide informed consent, if applicable

Exclusion Criteria:

• Current or prior history of anal or cervical cancer
• Permanent or irreversible bleeding disorder that would interfere with biopsy of the anal canal

Contacts and Locations

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Locations

United States, California
LA Gay & Lesbian Community Service Ctr., Lamba Med. Group CRS
Los Angeles, California, United States, 90028
Castro-Mission Health Ctr. CRS
San Francisco, California, United States, 94114
United States, Colorado
Univ. of Colorado Health Science Ctr. CRS
Denver, Colorado, United States, 80204-4507
Eastside Family Health Ctr. CRS
Denver, Colorado, United States, 80205
United States, District of Columbia
Washington DC VAMC, Washington Regional AIDS Program, Infectious Diseases CRS
Washington, District of Columbia, United States, 20422
United States, Florida
Univ. of Florida, Div. of Infectious Diseases CRS
Jacksonville, Florida, United States, 32206
United States, Massachusetts
CRI-Boston CRS
Boston, Massachusetts, United States, 02115
United States, Michigan
Henry Ford Hosp. CRS
Detroit, Michigan, United States, 48202
United States, New York
Harlem Hospital Ctr./Columbia University CRS (Gordin CTU)
New York, New York, United States, 10037-1802
United States, Oregon
Kaiser Immune Deficiency Clinic of Portland CRS
Portland, Oregon, United States, 97227
Oregon Health & Sciences Univ. Internal Medicine (L-475) CRS
Portland, Oregon, United States, 97239
United States, Pennsylvania
Temple Univ. School of Medicine CRS
Philadelphia, Pennsylvania, United States, 19140
United States, Texas
Houston AIDS Research Team CRS
Houston, Texas, United States, 77030

Sponsors and Collaborators

National Institute of Allergy and Infectious Diseases (NIAID)

Investigators

Study Chair:	Calvin Cohen, MD, MSc	Community Research Initiative of New England

More Information

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Additional Information:

Click here for more information on CPCRA 065 

Publications:

Panther LA, Schlecht HP, Dezube BJ. Spectrum of human papillomavirus-related dysplasia and carcinoma of the anus in HIV-infected patients. AIDS Read. 2005 Feb;15(2):79-82, 85-6, 88, 91. Review.

Heard I, Palefsky JM, Kazatchkine MD. The impact of HIV antiviral therapy on human papillomavirus (HPV) infections and HPV-related diseases. Antivir Ther. 2004 Feb;9(1):13-22. Review.

Piketty C, Darragh TM, Da Costa M, Bruneval P, Heard I, Kazatchkine MD, Palefsky JM. High prevalence of anal human papillomavirus infection and anal cancer precursors among HIV-infected persons in the absence of anal intercourse. Ann Intern Med. 2003 Mar 18;138(6):453-9.

Manzione CR, Nadal SR, Calore EE. [Human papillomavirus oncogenicity and grade of anal intraepithelial neoplasia in HIV positive patients]. Rev Assoc Med Bras (1992). 2004 Jul-Sep;50(3):282-5. Epub 2004 Oct 21. Portuguese.

Responsible Party:	National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier:	NCT00107679 History of Changes
Other Study ID Numbers:	CPCRA 065G; SMART; 10117 ( Registry Identifier: DAIDS-ES )
First Posted:	April 7, 2005
Last Update Posted:	April 17, 2014
Last Verified:	April 2014

Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):

Treatment Experienced; HIV; HPV; Antiretroviral Therapy, Highly Active; Papillomavirus, Human

Additional relevant MeSH terms:

HIV Infections; Anus Neoplasms; Lentivirus Infections; Retroviridae Infections; RNA Virus Infections; Virus Diseases; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; Immunologic Deficiency Syndromes; Immune System Diseases; Rectal Neoplasms	Colorectal Neoplasms; Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Intestinal Diseases; Anus Diseases; Rectal Diseases