Abstract
The incidence of anal cancer is increasing worldwide, especially in male homosexual patients. The main risk factor for development of anal cancer is anal infection with the human papillomavirus (HPV). The prevalence of anal HPV infection in HIV-negative homosexual men is 50–60%, while in HIV-positive homosexual men the prevalence is nearly 100%. HPV-related anal intraepithelial neoplasia (AIN) is the putative precursor of anal cancer. AIN can be found in approximately 20% of HIV-negative homosexual men and 5–10% of these patients have high-grade dysplasia (AIN II–III). The prevalence of high-grade dysplasia in HIV-positive homosexual men is, however, significantly higher being up to 50%. Despite the prevalence of HPV-related anal dysplasia and the increasing number of patients with anal cancer, there is still a lack of consensus regarding screening, surveillance and therapy of patients with AIN. The standard treatment for anal cancer is still radiochemotherapy with 5-FU and mitomycin C independent of the HPV or HIV status.
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