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Review
. 2009 Sep;21(5):433-8.
doi: 10.1097/CCO.0b013e32832f511a.

Anal cancer prevention in HIV-positive men and women

Joel M Palefsky  1
Affiliations
Review

Anal cancer prevention in HIV-positive men and women

Joel M Palefsky. Curr Opin Oncol. 2009 Sep.

Abstract

Purpose of review: The incidence of human papillomavirus-associated anal cancer is unacceptably high among HIV-positive men who have sex with men, and possibly in HIV-positive women. Unlike most other malignancies occurring in the HIV-positive population, anal cancer is potentially preventable, using methods similar to those used to prevent cervical cancer in women. This review discusses the issues around screening to prevent anal cancer.

Recent findings: Recent studies show that the incidence of anal cancer has increased since the introduction of highly active antiretroviral therapy in this population and now exceeds the highest incidence of cervical cancer among women reported anywhere in the world.

Summary: The high incidence of anal cancer among HIV-positive individuals must not be ignored, since it may be preventable. Given the current evidence and analogy with the cervical cancer prevention model, many clinicians believe that identification and treatment of high-grade anal intraepithelial neoplasia to prevent anal cancer are warranted. When the expertise to do so exists, this is a reasonable approach, particularly if coupled with efforts to optimize further screening and treatment approaches, as well as efforts to document the efficacy of high-grade anal intraepithelial neoplasia treatment to reduce the incidence of anal cancer.

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Conflict of interest statement

Conflict of interest: Dr. Palefsky receives grant support from Merck and Co.

References

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    1. Watson AJ, Smith BB, Whitehead MR, Sykes PH, Frizelle FA. Malignant progression of anal intra-epithelial neoplasia. ANZ journal of surgery. 2006 Aug;76(8):715–7. - PubMed
    1. Berry JM, Palefsky JM, Jay N, Cheng SC, Darragh TM, Chin-Hong PV. Performance characteristics of anal cytology and human papillomavirus testing in patients with high-resolution anoscopy-guided biopsy of high-grade anal intraepithelial neoplasia. Dis Colon Rectum. 2009 Feb;52(2):239–47. This study examined the sensitivity of abnormal anal cytology to detect high-grade anal neoplasia. In HIV-positive men the sensitivity was 87 percent, and in HIV-negative MSM it was 55 percent. - PubMed
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