Evaluation and Management of Anal Intraepithelial Neoplasia in HIV-Negative and HIV-Positive Men Who Have Sex with Men.
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.
Park
Ina U
IU
Palefsky
Joel M
JM
Am J Med. 2000 Jun 1;108(8):634-41
10856411
Clin Infect Dis. 2004 May 15;38(10):1490-2
15156490
Br J Surg. 2005 Sep;92(9):1133-6
16044425
J Natl Cancer Inst Monogr. 2003;(31):14-9
12807940
J Infect Dis. 1998 Feb;177(2):361-7
9466522
J Acquir Immune Defic Syndr. 2001 Dec 15;28(5):422-8
11744829
Acta Cytol. 1997 Jul-Aug;41(4):1167-70
9250316
Ann Intern Med. 2008 May 20;148(10):728-36
18490686
J Acquir Immune Defic Syndr. 2008 Jan 1;47(1):56-61
18156992
J Public Health (Oxf). 2008 Sep;30(3):293-304
18559368
J Acquir Immune Defic Syndr. 2004 Aug 1;36(4):915-20
15220697
Lancet. 2007 Jun 2;369(9576):1861-1868
17544766
Cancer. 2008 Nov 15;113(10 Suppl):2892-900
18980293
Int J STD AIDS. 2008 Jul;19(7):445-9
18574114
BMJ. 2009 Oct 08;339:b3884
19815582
Dis Colon Rectum. 2009 Feb;52(2):239-47
19279418
Dis Colon Rectum. 2006 Jan;49(1):36-40
16283561
N Engl J Med. 1987 Oct 15;317(16):973-7
2821396
J Natl Cancer Inst. 2009 Aug 19;101(16):1120-30
19648510
J Infect Dis. 2004 Dec 15;190(12):2070-6
15551204
Int J Cancer. 2009 May 15;124(10):2375-83
19189402
Dis Colon Rectum. 2007 May;50(5):565-75
17380365
Dis Colon Rectum. 2008 Jun;51(6):829-35; discussion 835-7
18363070
J Invest Dermatol. 2008 Aug;128(8):2078-83
18273049
AIDS. 2005 Sep 2;19(13):1407-14
16103772
AIDS. 2009 Jun 1;23(9):1135-42
19390418
AIDS. 2008 Jun 19;22(10):1203-11
18525266
Int J STD AIDS. 2008 Feb;19(2):118-20
18334066
MMWR Recomm Rep. 2009 Apr 10;58(RR-4):1-207; quiz CE1-4
19357635
ANZ J Surg. 2006 Aug;76(8):715-7
16916390
AIDS. 1998 Mar 26;12(5):495-503
9543448
J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Apr 15;14(5):415-22
9170415
Ann Intern Med. 2008 Sep 2;149(5):300-6
18765699
J Acquir Immune Defic Syndr. 2008 Aug 1;48(4):491-9
18614927
Sex Transm Dis. 2009 Aug;36(8):493-7
19617869
MMWR Morb Mortal Wkly Rep. 2009 Sep 18;58(36):997-1001
19763075
JAMA. 2002 Apr 24;287(16):2114-9
11966386
Clin Infect Dis. 2006 Jul 15;43(2):223-33
16779751
Arch Dermatol. 2006 Nov;142(11):1438-44
17116834
Int J Cancer. 2008 Jul 1;123(1):187-94
18435450
JAMA. 1999 May 19;281(19):1822-9
10340370
Dis Colon Rectum. 2009 Jan;52(1):31-9
19273953
J Acquir Immune Defic Syndr. 2009 Dec 1;52(4):474-9
19779306
Sex Transm Dis. 2005 Jun;32(6):351-7
15912081