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Topics, Trends & Updates
January 2016
Website Trends 2015: Top 10 Guidelines & Locations
     
Of the more than 100 guidelines on hivguidelines.org, the 10 listed below received the most page views in 2015. (Each title is a link.)
Top locations of site visitors: In 2015, approximately 325,000 users logged 600,000 page views on hivguidelines.org. Slightly more than 50% of visitors were from locations within the United States, but the site was also used regularly by visitors from around the world.
 
Countries
US States
US Cities
New York Locations
  1. United States
  2. India
  3. United Kingdom
  4. Kenya
  5. South Africa
  6. Canada
  7. Indonesia
  8. Thailand
  9. Australia
  10. Philippines
  1. New York
  2. California
  3. Florida
  4. Texas
  5. Maryland
  6. Illinois
  7. Pennsylvania
  8. Massachusetts
  9. New Jersey
  10. Georgia
  1. New York
  2. Chicago
  3. Los Angeles
  4. San Francisco
  5. Houston
  6. Washington
  7. Philadelphia
  8. Dallas
  9. Boston
  10. Atlanta
  1. New York City
  2. Rochester
  3. Albany
  4. Buffalo
  5. Manhasset
  6. Syracuse
  7. Yonkers
  8. Hauppauge
  9. Binghamton
  10. Schenectady

Hot Topics
What We're Reading
Detection of Invasive Anal Cancer in HIV-Infected Patients
Christopher J. Hoffmann, MD, MPH, Johns Hopkins University School of Medicine
 
Although invasive anal cancer is relatively rare, the disease can be devastating. The incidence of this cancer is increased among people living with HIV, especially among those who engage in receptive anal sex. For someone living with HIV in the United States or Canada, the cumulative incidence for anal cancer by the age of 65 has been estimated to be 1.3% compared with 0.03% for someone without HIV [Silverberg et al., Ann Int Med 2015]. This cumulative incidence exceeds those for colorectal, liver, and pharyngeal cancer.

Clinical guidelines for prevention of anal cancer borrow heavily from the cervical cancer literature, with limited data to support specific screening and management practices. Routine screening generally includes anal cytology without HPV typing. A recent article by D'Souza and colleagues adds to the knowledge base of anal cancer. They studied the incidence and clearance of squamous intraepithelial lesions, as well as high-risk HPV infection, among HIV-infected and uninfected men who have sex with men (MSM) in the United States [J Acquir Immune Defic Syndr 2016]. The authors describe longitudinal follow-up for 1511 men with repeat anal cytology separated by 2 years; 723 were living with HIV; 788 did not have HIV. Most of those with HIV had undetectable viral loads (78%), and the median CD4 cell count was 583 cells/mm3. Abnormal cytology (of any kind) was identified among 40% of the men living with HIV and in 25% of those without HIV. Only 1.5% of men had high-grade squamous intraepithelial lesions. However, 2.4% had atypical squamous cells for which high-grade lesions could not be excluded. Among HIV-infected men who received repeat cytologic testing after initial ASCUS (atypical cells of undetermined significance) or low-grade squamous intraepithelial lesions, 56% regressed to normal cytology; 81% of those with high-grade cytologic findings regressed to a lower grade. High-risk HPV 16 was identified among 25% of men living with HIV and 16% of those without HIV. Among 220 men who received follow-up high-resolution anoscopy with biopsy after cytologic findings of high-grade lesions, 17% had histologically confirmed disease.

This study adds to the data on the high prevalence of anal HPV infection and cellular changes among MSM with HIV. It also highlights the limitation of cytology to identify individuals who should receive high-resolution anoscopy and biopsy, given the frequency of regression of lower-grade lesions to normal. Additional studies are underway that could shed more light on prevention of anal cancer and management of high- and low-grade lesions. Until results are available from those studies, the common practice of routine cytologic testing and referral for high-grade lesions, as well as for atypical squamous cells for which high-grade lesions cannot be excluded, remains a reasonable approach.
Don't Miss
PrEP for Adolescents: Statewide Forum on Implementation
Materials from the first statewide forum on PrEP for Adolescents (November 18, 2015) and other resources are now available online. 

Learn More
PrEP for Adults: Report on the August Forum  Now Available 
This final report on the August 2015 NYSDOH AIDS Institute forum on PrEP Implementation for Adults is now available.

Materials from this
November 2015 meeting are now available, including workshop presentations, posters, and photos

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HIV Clinical Guidelines Program 
New York State Department of Health AIDS Institute
In collaboration with JHU School of Medicine, Division of Infectious Diseases
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