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Establishing an Anal Neoplasia Screening Service for a Unique HIV Positive Patient Population in a Small City: Lessons Learned

Charles D. Sturgis


Mortality from human papillomavirus (HPV) mediated squamous carcinoma of the uterine cervix has dramatically decreased in recent decades as a result of broad scale population screening for early detection of cervical cancer precursors. Concomitantly, deaths associated with HPV related carcinomas of the anus have oppositely trended upward. At this time, there are no national guidelines for anal screening. We herein report our experience with establishing an anal cytology screening program for HIV infected patients in a small city. The HIV positive population studied is unique in that 75% of patients had undetectable viral loads by PCR with average CD4+ cell/uL counts of 550. In addition 40% are adult females. 45% of patients in this relatively healthy HIV+ population were discovered to have atypical squamous cells or worse on entry into screening, and 20% of patients were ultimately shown on high resolution anoscopic biopsy histology to harbor high grade squamous intraepithelial lesions (AIN 2/3). Meaningful small scale anal cytology screening programs are possible with clinical and anoscopic collaborations. It seems possible that this simple and inexpensive test may prevent morbidity and mortality from HPV mediated anal carcinoma.


Anus; Screening; Dysplasia; Cytology; HIV


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