Screening HIV-infected individuals for anal cancer precursor lesions: a systematic review.
Individuals with human immunodeficiency virus (HIV) infection are at increased risk for human papillomavirus-related squamous cell cancer of the anus. Screening HIV-infected patients for squamous cell cancer of the anus and human papillomavirus-related anal dysplasia may prevent excess morbidity and mortality. We have conducted a systematic review of the indirect evidence in the literature regarding the utility of anal Papanicolau (Pap) smear screening of HIV-infected individuals in the highly active antiretroviral therapy era. Although there are no published studies evaluating the efficacy of anal Pap smear screening for preventing squamous cell cancer of the anus or anal intraepithelial neoplasia, we reviewed data regarding the burden of disease, anal Pap smear sensitivity and specificity, the prevalence of anal dysplasia, and 1 cost effectiveness study. The available evidence demonstrates that HIV-infected individuals have an increased risk for squamous cell cancer of the anus and anal intraepithelial neoplasia. This review identifies important areas for further study before routine anal Pap smear screening can be recommended.
Chiao
Elizabeth Y
EY
Baylor College of Medicine, Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, TX, USA. echiao@bcm.tmc.edu
Giordano
Thomas P
TP
Palefsky
Joel M
JM
Tyring
Stephen
S
El Serag
Hashem
H
D023241:Antiretroviral Therapy, Highly Active; D001005:Anus Neoplasms / Q000175:diagnosis* / Q000209:etiology; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008403:Mass Screening; D065006:Papanicolaou Test; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000209:etiology; D014626:Vaginal Smears