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
Highlights
Anal cancer incidence has increased in the past few years, and nowadays it is one of the most frequent cancers diagnosed in people with HIV [1]
Eighty-seven consecutive MSM HIV-infected patients were screened for anal cytology
We have evaluated cytology and HPV typing respectively in PAP smears and anal swab of HIV positive homo/bisexuals men attending our centre and analyzed correlation between PAP smears’ results and traditional anoscopy with biopsy and histological examination
Summary
Anal cancer incidence has increased in the past few years, and nowadays it is one of the most frequent cancers diagnosed in people with HIV [1]. A North American cohort study lasted from 1996 to 2007 showed that unadjusted anal cancer incidence rates per 100,000 were 131 person-years for HIV positive MSM, 46 for HIV-positive heterosexual men and 2 for HIV uninfected general male population [2]. HIV positive MSM have a doubled estimated risk compared to seronegative MSM and sixty times greater than general population [3]. Even HIV positive women and heterosexuals men have an increased risk of developing anal cancer [4]. In HIV-positive population an increased risk of progression from low-grade to high-grade dysplasia is described
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