Review: Anal Intraepithelial Neoplasia in HIV-Infected Men Who Have Sex with Men: Is Screening and Treatment Justified?

Wasserman, Peter; Rubin, David; Turett, Glenn S.

doi:10.1089/apc.2017.0063

Cited by 26 publications

(23 citation statements)

References 96 publications

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“…An important difference compared with the cervix is that excisions in the anal canal are associated with more adverse outcomes, which can have long‐term complications and affect anal sphincter functions . The decision to treat AIN2/AIN3 and the type of treatment depends on factors such as the size and location of the lesion.…”

Section: Strategies For Anal Cancer Screening and Early Detectionmentioning

confidence: 99%

“…48,49 An important difference compared with the cervix is that excisions in the anal canal are associated with more adverse outcomes, which can have long-term complications and affect anal sphincter functions. [50][51][52] The decision to treat AIN2/AIN3 and the type of treatment depends on factors such as the size and location of the lesion. Unlike cervical precancer, smaller lesions tend to be treated more often than larger lesions owing to the ease of treating these lesions with topical therapy or excision.…”

Section: Treatment Of Cervical and Anal Precancersmentioning

confidence: 99%

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Strategies for screening and early detection of anal cancers: A narrative and systematic review and meta‐analysis of cytology, HPV testing, and other biomarkers

Clarke

Wentzensen

2018

Cancer Cytopathology

110

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Anal cancer incidence and mortality have been increasing over the past decade. Although the incidence in the general population remains low, it is much higher in certain subgroups, including those living with human immunodeficiency virus and men who have sex with men. Approximately 90% of anal squamous cell cancers are caused by infection with carcinogenic human papillomavirus (HPV). Given the common etiology between anal and cervical carcinogenesis, screening for anal cancer has been proposed in certain high-risk populations using strategies adapted from cervical cancer prevention. In this review, the authors discuss important differences in anal and cervical cancer regarding the populations at risk, disease natural history, and clinical procedures and outcomes that need to be considered when evaluating strategies for anal cancer screening. They also performed a systematic review and meta-analysis of the performance of anal cytology, anal HPV testing, and various biomarkers for the detection of anal precancers and cancers. The implications of these performance estimates are summarized in the context of risk-based screening and management of anal precancers, and important research gaps are highlighted that need to be addressed to fully understand the benefits and harms of anal cancer screening. Cancer Cytopathol 2018. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

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Section: Strategies For Anal Cancer Screening and Early Detectionmentioning

confidence: 99%

Section: Treatment Of Cervical and Anal Precancersmentioning

confidence: 99%

Strategies for screening and early detection of anal cancers: A narrative and systematic review and meta‐analysis of cytology, HPV testing, and other biomarkers

Clarke

Wentzensen

2018

Cancer Cytopathology

110

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“…Anal SCC is one of the most prevalent cancers in HIV-infected patients and the fourth most common cancer in HIV-infected men who have sex with men (69). Approximately 90% of anal SCC in these patients has been associated with HPV infection (69). HPV is the most common sexually transmitted infection and is associated with anogenital warts, intraepithelial neoplasia, and anal carcinoma.…”

Section: Anal Sccmentioning

confidence: 99%

HIV-related Malignancies and Mimics: Imaging Findings and Management

Javadi¹,

Menias²,

Karbasian³

et al. 2018

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The risk of developing malignancy is higher in patients with human immunodeficiency virus (HIV) infection than in non-HIV-infected patients. Several factors including immunosuppression, viral coinfection, and high-risk lifestyle choices lead to higher rates of cancer in the HIV-infected population. A subset of HIV-related malignancies are considered to be acquired immunodeficiency syndrome (AIDS)-defining malignancies, as their presence confirms the diagnosis of AIDS in an HIV-infected patient. The introduction of highly active antiretroviral therapy (HAART) has led to a significant drop in the rate of AIDS-defining malignancies, including Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical carcinoma. However, non-AIDS-defining malignancies (eg, Hodgkin lymphoma, lung cancer, hepatocellular carcinoma, and head and neck cancers) now account for an increasing number of cancer cases diagnosed in HIV-infected patients. Although the number has decreased, AIDS-defining malignancies account for 15%-19% of all deaths in HIV-infected patients in the post-HAART era. Most HIVrelated malignancies in HIV-infected patients manifest at an earlier age with a more aggressive course than that of non-HIV-related malignancies. Understanding common HIV-related malignancies and their specific imaging features is crucial for making an accurate and early diagnosis, which impacts management. Owing to the weakened immune system of HIV-infected patients, other entities such as various infections, particularly opportunistic infections, are prevalent in these patients. These processes can have confounding clinical and imaging manifestations that mimic malignancy. This article reviews the most common AIDS-defining and non-AIDS-defining malignancies, the role of imaging in their diagnosis, and the imaging mimics of malignancies in HIV-infected patients. ©

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“…People living with HIV (PLHIV) are at increased risk of high-risk (HR)-HPV infection and persistence, (1) anal high-grade squamous intraepithelial lesions (HSIL+) or high-grade anal intraepithelial neoplasia (AIN2+) and incidence of anal cancer. (2,3) Anal cancer is the fourth most common cancer among men who have sex with men (MSM) living with HIV, (4) and evidence suggests higher rates of anal cancer among women living with HIV (WLHIV) and men who have sex with women (MSW) living with HIV compared to their HIV-negative counterparts. (3,(5)(6)(7) As antiretroviral therapy (ART) is scaled-up, longer survival times among PLHIV may be associated with an increase in the rates of anal and other cancers.…”

Section: Introductionmentioning

confidence: 99%

Association of antiretroviral therapy with anal high-risk human papillomavirus, anal intraepithelial neoplasia, and anal cancer in people living with HIV: a systematic review and meta-analysis

et al. 2020

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BACKGROUND: The effect of antiretroviral therapy (ART) on the natural history of anal HR-HPV and anal lesion progression is not well established. We reviewed the association of ART and other HIV-related factors on anal HPV infection, anal intraepithelial neoplasia (AIN), and anal cancer among people living with HIV (PLHIV). METHODS: We searched Medline and Embase for studies from 1 January 1996 to 30 October 2019 that reported the association of HIV-related exposures (ART, HIV-RNA plasma viral load [PVL] and nadir or current CD4+ cell count) with outcomes of anal HR-HPV prevalence, incidence or persistence or prevalence, incidence, progression or regression of anal histological/cytological abnormalities, or anal cancer incidence. We assessed the risk of bias of included studies using the Newcastle-Ottawa scale. We performed random-effects meta-analyses; heterogeneity was examined using I 2 statistic. FINDINGS: 122 studies were included comprising 417,006 PLHIV (19%, 44% and 5% women, men-whohave-sex-with-men; men-who-have-sex-with-women, respectively; 32% of studies did not stratify findings by gender and/or sexual orientation). PLHIV taking ART had 35% lower HR-HPV prevalence compared to ART-naïve (crude Odds Ratio[cOR]=0.65, 95%CI:0.54-0.79; I 2 =12.1%) in 18 studies and prolonged ART use was associated with a 10% reduction in HR-HPV prevalence in two studies (per year: aOR=0.90, 95%CI:0.85-0.95, I 2 =0.0%). PLHIV with undetectable PVL had lower HSIL/AIN2+ prevalence compared to those without (cOR=0.84, 95%CI:0.72-0.98, I 2 =0.0%) in 16 studies, particularly if sustained for >1 year (cOR=0.62, 95%CI:0.47-0.81, I 2 =0.0%). ART was not associated with anal cancer incidence when adjusted for years living with HIV in 3 studies (aHR=1.11, 95%CI: 0.68-1.80, I 2 =0.0%), but ART users with sustained undetectable HIV PVL had 44% lower risk of anal cancer compared to those without (aHR=0.56, 95%CI:0.44-0.70, I 2 =0%) and for each 100 cells/µl increase in nadir CD4+ count, there was a 40% decrease in anal cancer incidence (cHR=0.60, 95%CI:0.46-0.78, I 2 =21.7%). INTERPRETATION: Effective ART use and early initiation at higher nadir CD4+ may reduce anal HR-HPV and anal cancer risk.

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Review: Anal Intraepithelial Neoplasia in HIV-Infected Men Who Have Sex with Men: Is Screening and Treatment Justified?

Cited by 26 publications

References 96 publications

Strategies for screening and early detection of anal cancers: A narrative and systematic review and meta‐analysis of cytology, HPV testing, and other biomarkers

Strategies for screening and early detection of anal cancers: A narrative and systematic review and meta‐analysis of cytology, HPV testing, and other biomarkers

HIV-related Malignancies and Mimics: Imaging Findings and Management

Association of antiretroviral therapy with anal high-risk human papillomavirus, anal intraepithelial neoplasia, and anal cancer in people living with HIV: a systematic review and meta-analysis

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