Anal cancer screening for diagnosis and treatment of anal squamous intaepithelial lesions in HIV-positive MSM patients

Abstract

Incidence of anal cancer is increasing in HIV+ patients. We have structured a control program in HIV-positive MSM with anal PAP-test and HPV genotyping based on the outcome of anal cytology. Follow-up has been listed according to the HPV genotype infection. Traditional anoscopy and histological exam (also if no visible mucosal lesions, by quadrant random biopsies) was offered to every patient with every abnormal cytology for detection and treatment of squamous anal lesions. Of 87 subjects enrolled, 22 patients (25%) had pathological cytology and 65 patients had PAP-smear negative. No differences in demographic and immuo-virological profile were found in the two groups. Precancerous anal lesions and cancer (1 AIN2, 2 AIN3 and 1 SCC) were treated surgically if advanced otherwise with imiquimod cream into the anal canal; squamous cell carcinoma was referred to oncologist. High prevalence of HPV infection and anal intraepithelial neoplasia are important risk factors for anal cancer: anal precancerous lesions can be detected early and treated in at-risk populations. © 2013 Mercuri A, et al.