# Optimizing Age-based Anal Cancer Screening Among People Living with HIV using Decision Analytic Modeling

> **NIH NIH R01** · UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON · 2020 · $500,531

## Abstract

PROJECT SUMMARY/ABSTRACT
Anal cancer is the second most common non-AIDS defining cancer and a leading cause of morbidity among
HIV-infected (HIV+) persons in the United States (US). The incidence of anal cancer increases with age. With
nearly 50% HIV+ persons are now 50-years or older, preventative health care in the form of screening is a
major public health priority to decrease their risk of developing anal cancer. Because anal cancer is biologically
similar to cervical cancer, current guidelines (inferred from cervical cancer literature) recommend screening
HIV+ men and women using anal cytology for detection of high-grade squamous intraepithelial lesions (the
anal cancer precursor); however, optimal screening regimen (age to start and stop screening as well as
optimal screening frequency) for the prevention of anal cancer still remains unknown. Due to the lack of clear
understanding of harms versus benefits of screening, only 11% of HIV+ persons had an anal cytology in the
preceding year, leading to 50% of diagnoses occurring at stage III or worse when the 5-year survival rate is
less than 40%.
The goal of the proposed research is to identify appropriate candidates for screening and determine age-
specific screening algorithms to reduce anal cancer morbidity and mortality among HIV+ men and women. We
will integrate evidence from two large clinical trials and several large databases into mathematical modeling,
a complementary approach to randomized clinical trials. In Aim 1, we will measure the impact of age and HIV
disease status (i.e., HIV viral suppression, CD4 count) on the incidence of anal HSIL, HSIL recurrence, and
progression to anal cancer. In Aim 2, we will develop a clinically-valid mathematical model of anal cancer
natural history in HIV+ men and women and use it to determine optimal age-specific anal cancer screening
algorithm. Finally, in Aim 3, we propose to determine the minimum necessary efficacy (by age) of anal HSIL
treatment for HIV+ men and women to provide clinically significant benefits for screening and finally determine
areas of future research to improve the value of anal cancer screening.
The proposed research is innovative because it applies advanced modeling approach with multiple datasets to
address a problem that has not been solved by empirical methods. The research team is ideally suited, with an
established track record in HIV and HPV epidemiology, cancer outcomes research, and clinical care, having
substantial experience in developing mathematical models to inform clinical decision making. The end results
of the proposed study will be age-specific anal cancer screening recommendations for HIV+ men and women
that will inform anal cancer prevention policies and practice and ultimately reduce morbidity and mortality.

## Key facts

- **NIH application ID:** 9886218
- **Project number:** 5R01CA232888-02
- **Recipient organization:** UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
- **Principal Investigator:** Ashish A. Deshmukh
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $500,531
- **Award type:** 5
- **Project period:** 2019-03-05 → 2023-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9886218

## Citation

> US National Institutes of Health, RePORTER application 9886218, Optimizing Age-based Anal Cancer Screening Among People Living with HIV using Decision Analytic Modeling (5R01CA232888-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9886218. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*