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Anal intraepithelial neoplasia and squamous cell carcinoma in HIV ‐infected adults
Author(s) -
Tong WWY,
Hillman RJ,
Kelleher AD,
Grulich AE,
Carr A
Publication year - 2014
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12080
Subject(s) - anal cancer , medicine , natural history , squamous intraepithelial lesion , intraepithelial neoplasia , cancer , cervical intraepithelial neoplasia , cervical cancer , oncology , immunology , anal carcinoma , prostate
Anal cancer is one of the most common non‐ AIDS ‐defining malignancies in the era of combination antiretroviral therapy. Its precursor lesion, anal intraepithelial neoplasia ( AIN ), is highly prevalent in HIV ‐infected populations. More than 90% of anal squamous cell cancers are attributable to human papillomavirus ( HPV ). While the biology of HPV ‐related intraepithelial neoplasia is consistent across lower anogenital sites, the natural history of AIN is not well established and cannot be assumed to be identical to that of cervical intraepithelial neoplasia. Screening strategies to prevent anal cancer should be developed based on robust natural history data in HIV ‐infected and uninfected populations. Likewise, treatments need to be tested in randomized clinical trials, and reserved for those at significant risk of progression to cancer. This review covers the epidemiology, pathogenesis and immunology of HPV infection, AIN and anal cancer, and summarizes the current diagnosis, screening and treatment strategies in HIV ‐infected adults.