title: Evaluation and Management of Anal Intraepithelial Neoplasia in HIV-Negative and HIV-Positive Men Who Have Sex with Men.
abstract: The incidence of human papillomavirus (HPV)-associated anal cancer in men who have sex with men (MSM) is striking and has not been mitigated by the use of highly active antiretroviral therapy. Detection and treatment of high-grade anal intraepithelial neoplasia (HGAIN) may reduce the incidence of anal cancer. Anal cytology is a useful tool to detect HGAIN; annual screening of HIV-positive MSM and biennial screening of HIV-negative MSM appears to be cost-effective. MSM with abnormal cytology should be referred for high-resolution anoscopy and biopsy. Individuals with HGAIN should receive treatment; treatment modalities for HGAIN demonstrate moderate efficacy and are usually well tolerated, but greater study is required to determine which treatment is optimal. Large prospective studies are needed to document the efficacy of screening and treatment of HGAIN on anal cancer incidence. The HPV vaccine holds promise for primary prevention of anal cancer in MSM, but significant implementation challenges remain.
authors.forename: Ina U
authors.initials: IU
authors.lastname: Park
authors.forename: Joel M
authors.initials: JM
authors.lastname: Palefsky
references.citation: Am J Med. 2000 Jun 1;108(8):634-41
references.pmid: 10856411
references.citation: Clin Infect Dis. 2004 May 15;38(10):1490-2
references.pmid: 15156490
references.citation: Br J Surg. 2005 Sep;92(9):1133-6
references.pmid: 16044425
references.citation: J Natl Cancer Inst Monogr. 2003;(31):14-9
references.pmid: 12807940
references.citation: J Infect Dis. 1998 Feb;177(2):361-7
references.pmid: 9466522
references.citation: J Acquir Immune Defic Syndr. 2001 Dec 15;28(5):422-8
references.pmid: 11744829
references.citation: Acta Cytol. 1997 Jul-Aug;41(4):1167-70
references.pmid: 9250316
references.citation: Ann Intern Med. 2008 May 20;148(10):728-36
references.pmid: 18490686
references.citation: J Acquir Immune Defic Syndr. 2008 Jan 1;47(1):56-61
references.pmid: 18156992
references.citation: J Public Health (Oxf). 2008 Sep;30(3):293-304
references.pmid: 18559368
references.citation: J Acquir Immune Defic Syndr. 2004 Aug 1;36(4):915-20
references.pmid: 15220697
references.citation: Lancet. 2007 Jun 2;369(9576):1861-1868
references.pmid: 17544766
references.citation: Cancer. 2008 Nov 15;113(10 Suppl):2892-900
references.pmid: 18980293
references.citation: Int J STD AIDS. 2008 Jul;19(7):445-9
references.pmid: 18574114
references.citation: BMJ. 2009 Oct 08;339:b3884
references.pmid: 19815582
references.citation: Dis Colon Rectum. 2009 Feb;52(2):239-47
references.pmid: 19279418
references.citation: Dis Colon Rectum. 2006 Jan;49(1):36-40
references.pmid: 16283561
references.citation: N Engl J Med. 1987 Oct 15;317(16):973-7
references.pmid: 2821396
references.citation: J Natl Cancer Inst. 2009 Aug 19;101(16):1120-30
references.pmid: 19648510
references.citation: J Infect Dis. 2004 Dec 15;190(12):2070-6
references.pmid: 15551204
references.citation: Int J Cancer. 2009 May 15;124(10):2375-83
references.pmid: 19189402
references.citation: Dis Colon Rectum. 2007 May;50(5):565-75
references.pmid: 17380365
references.citation: Dis Colon Rectum. 2008 Jun;51(6):829-35; discussion 835-7
references.pmid: 18363070
references.citation: J Invest Dermatol. 2008 Aug;128(8):2078-83
references.pmid: 18273049
references.citation: AIDS. 2005 Sep 2;19(13):1407-14
references.pmid: 16103772
references.citation: AIDS. 2009 Jun 1;23(9):1135-42
references.pmid: 19390418
references.citation: AIDS. 2008 Jun 19;22(10):1203-11
references.pmid: 18525266
references.citation: Int J STD AIDS. 2008 Feb;19(2):118-20
references.pmid: 18334066
references.citation: MMWR Recomm Rep. 2009 Apr 10;58(RR-4):1-207; quiz CE1-4
references.pmid: 19357635
references.citation: ANZ J Surg. 2006 Aug;76(8):715-7
references.pmid: 16916390
references.citation: AIDS. 1998 Mar 26;12(5):495-503
references.pmid: 9543448
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Apr 15;14(5):415-22
references.pmid: 9170415
references.citation: Ann Intern Med. 2008 Sep 2;149(5):300-6
references.pmid: 18765699
references.citation: J Acquir Immune Defic Syndr. 2008 Aug 1;48(4):491-9
references.pmid: 18614927
references.citation: Sex Transm Dis. 2009 Aug;36(8):493-7
references.pmid: 19617869
references.citation: MMWR Morb Mortal Wkly Rep. 2009 Sep 18;58(36):997-1001
references.pmid: 19763075
references.citation: JAMA. 2002 Apr 24;287(16):2114-9
references.pmid: 11966386
references.citation: Clin Infect Dis. 2006 Jul 15;43(2):223-33
references.pmid: 16779751
references.citation: Arch Dermatol. 2006 Nov;142(11):1438-44
references.pmid: 17116834
references.citation: Int J Cancer. 2008 Jul 1;123(1):187-94
references.pmid: 18435450
references.citation: JAMA. 1999 May 19;281(19):1822-9
references.pmid: 10340370
references.citation: Dis Colon Rectum. 2009 Jan;52(1):31-9
references.pmid: 19273953
references.citation: J Acquir Immune Defic Syndr. 2009 Dec 1;52(4):474-9
references.pmid: 19779306
references.citation: Sex Transm Dis. 2005 Jun;32(6):351-7
references.pmid: 15912081