Review Article

Screening HIV-Infected Men for Anal Dysplasia and Cancer: Are Practice Guidelines Needed?

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ABSTRACT

Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) have an increased risk of developing squamous cell carcinoma of the anus (SCCA) and precancerous anal dysplasia. Anal cancer precursor lesions may develop due to infection with high-risk strains of human papillomavirus (HPV) combined with the near-normal lifespan afforded by advancements in HIV care. No clinical practice guidelines currently exist for anal dysplasia or cancer screening in this high-risk population. The objective of this study was to determine if current knowledge and evidence support the creation of clinical practice guidelines for screening HIV-infected MSM for SCCA and anal dysplasia. A literature review of evidence for screening combined with a retrospective chart review of the first 212 HIV-infected males evaluated within a Seattle-based anal dysplasia clinic was undertaken. The purpose was to review incidence of SCCA and precursor lesions identified using digital rectal examination and anal cytology in combination with high-resolution anoscopy (HRA) within the author’s clinic. Patient characteristics were examined to see if factors correlated with these diagnoses. Although results from the anal dysplasia clinic are compelling for early diagnosis of SCCA and anal dysplasia in HIV-infected MSM, additional research investigating the clinical efficacy and cost-effectiveness of anal cytology combined with HRA and targeted biopsy is needed. A review of the literature did not contain recommendations for screening guidelines for the HIV-infected MSM population.

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