Neoplasia intraepitelial anal en pacientes de riesgo: ¿cómo y a quién realizar un programa de cribado?

Sr. Editor, en referencia al interesante artículo publicado por Silva y cols., creemos importante comentar algunos aspectos relativos a la citología anal como herramienta de cribado de neoplasia intraepitelial anal (AIN) en pacientes de riesgo

Same-day SARS-CoV-2 antigen test screening in an indoor mass-gathering live music event: a randomised controlled trial

Background The banning of mass-gathering indoor events to prevent SARS-CoV-2 spread has had an important effect on local economies. Despite growing evidence on the suitability of antigen-detecting rapid diagnostic tests (Ag-RDT) for mass screening at the event entry, this strategy has not been assessed under controlled conditions. We aimed to assess the effectiveness of a prevention strategy during a live indoor concert. Methods We designed a randomised controlled open-label trial to assess the effectiveness of a comprehensive preventive intervention for a mass-gathering indoor event (a live concert) based on systematic same-day screening of attendees with Ag-RDTs, use of facial masks, and adequate air ventilation. The event took place in the Sala Apolo, Barcelona, Spain. Adults aged 18–59 years with a negative result in an Ag-RDT from a nasopharyngeal swab collected immediately before entering the event were randomised 1:1 (block randomisation stratified by age and gender) to either attend the indoor event for 5 hours or go home. Nasopharyngeal specimens used for Ag-RDT screening were analysed by real-time reverse-transcriptase PCR (RT-PCR) and cell culture (Vero E6 cells). 8 days after the event, a nasopharyngeal swab was collected and analysed by Ag-RDT, RT-PCR, and a transcription-mediated amplification test (TMA). The primary outcome was the difference in incidence of RT-PCR-confirmed SARS-CoV-2 infection at 8 days between the control and the intervention groups, assessed in all participants who were randomly assigned, attended the event, and had a valid result for the SARS-CoV-2 test done at follow-up. The trial is registered at ClinicalTrials.gov, NCT04668625. Findings Participant enrollment took place during the morning of the day of the concert, Dec 12, 2020. Of the 1140 people who responded to the call and were deemed eligible, 1047 were randomly assigned to either enter the music event (experimental group) or continue with normal life (control group). Of the 523 randomly assigned to the experimental group, 465 were included in the analysis of the primary outcome (51 did not enter the event and eight did not take part in the follow-up assessment), and of the 524 randomly assigned to the control group, 495 were included in the final analysis (29 did not take part in the follow-up). At baseline, 15 (3%) of 495 individuals in the control group and 13 (3%) of 465 in the experimental group tested positive on TMA despite a negative Ag-RDT result. The RT-PCR test was positive in one case in each group and cell viral culture was negative in all cases. 8 days after the event, two (<1%) individuals in the control arm had a positive Ag-RDT and PCR result, whereas no Ag-RDT nor RT-PCR positive results were found in the intervention arm. The Bayesian estimate for the incidence between the experimental and control groups was –0·15% (95% CI –0·72 to 0·44). Interpretation Our study provides preliminary evidence on the safety of indoor mass-gathering events during a COVID-19 outbreak under a comprehensive preventive intervention. The data could help restart cultural activities halted during COVID-19, which might have important sociocultural and economic implications.Primavera Sound Group and the #YoMeCorono InitiativePeer ReviewedPostprint (author's final draft

Incidence of Recurrent High-Grade Anal Dysplasia in HIV-1-Infected Men and Women Following Infrared Coagulation Ablation: A Retrospective Cohort Study

This single-center, retrospective cohort study sought to estimate the cumulative incidence in HIV-1-infected patients of biopsy-proven high-grade anal intraepithelial neoplasia (HGAIN) recurrence after infrared coagulation (IRC) treatment. The study was based on data from a prospectively compiled database of 665 HIV-1-infected outpatients who attended a hospital Clinical Proctology/HIV Unit between January 2012 and December 2015. Patient records were checked to see which ones had received IRC treatment but later experienced a recurrence of HGAIN. Cytology samples were also checked for the presence of human papilloma virus (HPV). A total of 81 of the 665 patients (12%, 95%CI: 10-15%), of whom 65 were men and 16 women, were diagnosed with HGAIN and again treated with IRC. Of these 81, 20 (25%) experienced recurrent HGAIN, this incidence being true of both men (16/65, 95%CI: 19-57%) and women (4/16, 95%CI: 10-50%). The median time to recurrence was 6 (2-19) months overall, 6 (2-19) months in men, and 4 (2-6) months in women. HPV infection was detected in all patients except two, with HPV-16 being the most common genotype. This rate of incidence of recurrent HGAIN following IRC treatment is consistent with other reports and highlights the importance of continued post-treatment surveillance, particularly in the first year

Feasibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen self-testing in school and summer camp attendees

SARS-CoV-2 screening is one of the pillars of non-pharmaceutical preventive strategies to early identify and isolate infected individuals and therefore decrease community incidence. We assessed the feasibility of severe acute respiratory syndrome coronavirus 2 self-testing with antigen-detecting rapid diagnostic tests in attendees of educational settings. A total of 305 students (88.15%) and 41 staff (11.85%) from 9 to 56 years old participated in the self-testing procedure and answered the survey at the end of the study. 91.3% (n = 313) did not need help, 96.1% of participants reported the same outcome as the healthcare workers. 94.5% strongly or slightly agree with the statement "I would repeat the experience". The study demonstrates that self-testing is acceptable and usable in children, adolescents and adults when the epidemiological situation may require a systematic screening of these populations, although supervision by health care or previously trained personnel is recommended for younger age groups

Enhancement of Antiviral CD8 + T-Cell Responses and Complete Remission of Metastatic Melanoma in an HIV-1-Infected Subject Treated with Pembrolizumab

Background: Pembrolizumab is an immune checkpoint inhibitor against programmed cell death protein-1 (PD-1) approved for therapy in metastatic melanoma. PD-1 expression is associated with a diminished functionality in HIV-1 specific-CD8 + T cells. It is thought that PD-1 blockade could contribute to reinvigorate antiviral immunity and reduce the HIV-1 reservoir. Methods: Upon metastatic melanoma diagnosis, an HIV-1-infected individual on stable suppressive antiretroviral regimen was treated with pembrolizumab. A PET-CT was performed before and one year after pembrolizumab initiation. We monitored changes in the immunophenotype and HIV-1 specific-CD8 + T-cell responses during 36 weeks of treatment. Furthermore, we assessed changes in the viral reservoir by total HIV-1 DNA, cell-associated HIV-1 RNA, and ultrasensitive plasma viral load. Results: Complete metabolic response was achieved after pembrolizumab treatment of metastatic melanoma. Activated CD8 + T-cells expressing HLA-DR + /CD38 + transiently increased over the first nine weeks of treatment. Concomitantly, there was an augmented response of HIV-1 specific-CD8 + T cells with TNF production and poly-functionality, transitioning from TNF to an IL-2 profile. Furthermore, a transient reduction of 24% and 32% in total HIV-1 DNA was observed at weeks 3 and 27, respectively, without changes in other markers of viral persistence. Conclusions: These data demonstrate that pembrolizumab may enhance the HIV-1 specific-CD8 + T-cell response, marginally affecting the HIV-1 reservoir. A transient increase of CD8 + T-cell activation, TNF production, and poly-functionality resulted from PD-1 blockade. However, the lack of sustained changes in the viral reservoir suggests that viral reactivation is needed concomitantly with HIV-1-specific immune enhancement

Cancer immunotherapy in special challenging populations: recommendations of the Advisory Committee of Spanish Melanoma Group (GEM)

Cancer immunotherapy based on the use of antibodies targeting the so-called checkpoint inhibitors, such as programmed cell death-1 receptor, its ligand, or CTLA-4, has shown durable clinical benefit and survival improvement in melanoma and other tumors. However, there are some special situations that could be a challenge for clinical management. Persons with chronic infections, such as HIV-1 or viral hepatitis, latent tuberculosis, or a history of solid organ transplantation, could be candidates for cancer immunotherapy, but their management requires a multidisciplinary approach. The Spanish Melanoma Group (GEM) panel in collaboration with experts in virology and immunology from different centers in Spain reviewed the literature and developed evidence-based guidelines for cancer immunotherapy management in patients with chronic infections and immunosuppression. These are the first clinical guidelines for cancer immunotherapy treatment in special challenging populations. Cancer immunotherapy in chronically infected or immunosuppressed patients is feasible but needs a multidisciplinary approach in order to decrease the risk of complications related to the coexistent comorbidities

Feasibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen self-testing in school and summer camp attendees

BackgroundSARS-CoV-2 screening is one of the pillars of non-pharmaceutical preventive strategies to early identify and isolate infected individuals and therefore decrease community incidence.MethodsWe assessed the feasibility of severe acute respiratory syndrome coronavirus 2 self-testing with antigen-detecting rapid diagnostic tests in attendees of educational settings.ResultsA total of 305 students (88.15%) and 41 staff (11.85%) from 9 to 56 years old participated in the self-testing procedure and answered the survey at the end of the study. 91.3% (n = 313) did not need help, 96.1% of participants reported the same outcome as the healthcare workers. 94.5% strongly or slightly agree with the statement “I would repeat the experience”.ConclusionThe study demonstrates that self-testing is acceptable and usable in children, adolescents and adults when the epidemiological situation may require a systematic screening of these populations, although supervision by health care or previously trained personnel is recommended for younger age groups

Efectividad de un programa de cribado, basado en la citología anal, anoscopia de alta resolución y tratamiento ablativo, como estrategia para prevenir el cáncer anal invasivo en personas infectadas por el virus de la inmunodeficiencia humana

El carcinoma escamo celular anal invasivo es un cáncer muy raro en la población general, pero muy frecuente los pacientes infectados por el VIH, principalmente los Hombres que tienen Sexo con Hombres, aunque los Hombres que tienen sexo con Mujeres y las mujeres infectadas por el VIH tienen también un riesgo mucho más alto que la población general. Actualmente no existe evidencia sobre la eficacia de las distintas estrategias empleadas para detectar y tratar las displasias anales de alto grado, que potencialmente pueden avanzar a un carcinoma escamo celular anal invasivo. El propósito de la presente tesis es demostrar la efectividad de un programa de cribado de displasia anal basada en la realización de citologías anales y anoscopia de alta resolución como estrategia de cribado de las displasias anales de alto grado, con el fin de prevenir el carcinoma escamo celular anal invasivo.Invasive anal squamous-cell carcinoma is a rare cancer in the general population, but common in HIV-infected patients, especially in Men who have Sex with Men, although Men who have sex with Women and women infected with HIV they also have a much higher risk than the general population. There is currently no evidence on the efficacy of the different strategies used to detect and treat high-grade anal dysplasia, which can potentially advance to an invasive squamous cell carcinoma. The purpose of this thesis is to demonstrate the effectiveness of an anal dysplasia screening program based of anal cytology and high resolution anoscopy to prevent nvasive anal squamous-cell carcinoma

Efectividad de un programa de cribado, basado en la citología anal, anoscopia de alta resolución y tratamiento ablativo, como estrategia para prevenir el cáncer anal invasivo en personas infectadas por el virus de la inmunodeficiencia humana

El carcinoma escamo celular anal invasivo es un cáncer muy raro en la población general, pero muy frecuente los pacientes infectados por el VIH, principalmente los Hombres que tienen Sexo con Hombres, aunque los Hombres que tienen sexo con Mujeres y las mujeres infectadas por el VIH tienen también un riesgo mucho más alto que la población general. Actualmente no existe evidencia sobre la eficacia de las distintas estrategias empleadas para detectar y tratar las displasias anales de alto grado, que potencialmente pueden avanzar a un carcinoma escamo celular anal invasivo. El propósito de la presente tesis es demostrar la efectividad de un programa de cribado de displasia anal basada en la realización de citologías anales y anoscopia de alta resolución como estrategia de cribado de las displasias anales de alto grado, con el fin de prevenir el carcinoma escamo celular anal invasivo.Invasive anal squamous-cell carcinoma is a rare cancer in the general population, but common in HIV-infected patients, especially in Men who have Sex with Men, although Men who have sex with Women and women infected with HIV they also have a much higher risk than the general population. There is currently no evidence on the efficacy of the different strategies used to detect and treat high-grade anal dysplasia, which can potentially advance to an invasive squamous cell carcinoma. The purpose of this thesis is to demonstrate the effectiveness of an anal dysplasia screening program based of anal cytology and high resolution anoscopy to prevent nvasive anal squamous-cell carcinoma

Efectividad de un programa de cribado, basado en la citología anal, anoscopia de alta resolución y tratamiento ablativo, como estrategia para prevenir el cáncer anal invasivo en personas infectadas por el virus de la inmunodeficiencia humana

El carcinoma escamo celular anal invasivo es un cáncer muy raro en la población general, pero muy frecuente los pacientes infectados por el VIH, principalmente los Hombres que tienen Sexo con Hombres, aunque los Hombres que tienen sexo con Mujeres y las mujeres infectadas por el VIH tienen también un riesgo mucho más alto que la población general. Actualmente no existe evidencia sobre la eficacia de las distintas estrategias empleadas para detectar y tratar las displasias anales de alto grado, que potencialmente pueden avanzar a un carcinoma escamo celular anal invasivo. El propósito de la presente tesis es demostrar la efectividad de un programa de cribado de displasia anal basada en la realización de citologías anales y anoscopia de alta resolución como estrategia de cribado de las displasias anales de alto grado, con el fin de prevenir el carcinoma escamo celular anal invasivo.Invasive anal squamous-cell carcinoma is a rare cancer in the general population, but common in HIV-infected patients, especially in Men who have Sex with Men, although Men who have sex with Women and women infected with HIV they also have a much higher risk than the general population. There is currently no evidence on the efficacy of the different strategies used to detect and treat high-grade anal dysplasia, which can potentially advance to an invasive squamous cell carcinoma. The purpose of this thesis is to demonstrate the effectiveness of an anal dysplasia screening program based of anal cytology and high resolution anoscopy to prevent nvasive anal squamous-cell carcinoma