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Purpose <p>Anal carcinoma (AC) incidence in people with HIV (PWH) is increasing. Guideline-recommended anal-cytology screening facilitates early treatment of precancerous lesions. Data on real-world adherence to screening- and follow-up (F/U)-recommendations remain limited.</p> Methods <p>We analyzed routine anal-cytology screening in PWH at a German university hospital-clinic (2017–2023), including frequency of findings, F/U, and final diagnoses.</p> Results <p>The study-population included 434 persons with 936 anal-cytology results, representing 25% of person-time of F/U at our clinic. Median age was 55 years, female/male ratio was 5/429, 310 (71%) were MSM. Median CD4-nadir was 242/µl, in 97% viral load was suppressed, 47% were currently smoking.</p> <p>Of 936 swab-results, 882 (94%) were evaluable; 201 (21%) showed abnormalities. Among these, 60 (30%) were ASC-US, 77 (38%) LSIL, 12 (6%) ASC-H, and 52 (26%) HSIL. High-resolution-anoscopy (HRA), recommended for the 64 ASC-H/HSIL-cases, was performed in 7 (11%), identifying 1 AIN2. In 46/64 (72%) proctoscopy identified 1 AC and 3 cases each of AIN2/AIN3. Eleven persons (17%) refused F/U. Thus, 8/64 (12.5%) suspicious cytology findings were histopathologically confirmed. During the study period, 4 cases of AC were diagnosed in unscreened persons at our clinic.</p> Conclusion <p>Routine anal-cytology screening in an unsystematically selected cohort of 434 PWH contributing 1,383 person-years of F/U identified 7 cases of high-grade precancerous lesions and 1 asymptomatic AC. Important challenges included low uptake, limited specificity of cytology, inconsistent adherence to F/U recommendations, and insufficient availability of HRA. Improved communication of HIV-care-providers with all involved parties will be a key requirement for improving efficiency and outcomes.</p>

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Challenges and limitations of anal cancer and precancer screening among people with HIV in a real-world setting

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月26日

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  • V. Menzel,
  • E. Gruener,
  • J. Neuf,
  • S. Sammet,
  • S. Esser,
  • J. Roider,
  • U. Seybold

摘要

Purpose

Anal carcinoma (AC) incidence in people with HIV (PWH) is increasing. Guideline-recommended anal-cytology screening facilitates early treatment of precancerous lesions. Data on real-world adherence to screening- and follow-up (F/U)-recommendations remain limited.

Methods

We analyzed routine anal-cytology screening in PWH at a German university hospital-clinic (2017–2023), including frequency of findings, F/U, and final diagnoses.

Results

The study-population included 434 persons with 936 anal-cytology results, representing 25% of person-time of F/U at our clinic. Median age was 55 years, female/male ratio was 5/429, 310 (71%) were MSM. Median CD4-nadir was 242/µl, in 97% viral load was suppressed, 47% were currently smoking.

Of 936 swab-results, 882 (94%) were evaluable; 201 (21%) showed abnormalities. Among these, 60 (30%) were ASC-US, 77 (38%) LSIL, 12 (6%) ASC-H, and 52 (26%) HSIL. High-resolution-anoscopy (HRA), recommended for the 64 ASC-H/HSIL-cases, was performed in 7 (11%), identifying 1 AIN2. In 46/64 (72%) proctoscopy identified 1 AC and 3 cases each of AIN2/AIN3. Eleven persons (17%) refused F/U. Thus, 8/64 (12.5%) suspicious cytology findings were histopathologically confirmed. During the study period, 4 cases of AC were diagnosed in unscreened persons at our clinic.

Conclusion

Routine anal-cytology screening in an unsystematically selected cohort of 434 PWH contributing 1,383 person-years of F/U identified 7 cases of high-grade precancerous lesions and 1 asymptomatic AC. Important challenges included low uptake, limited specificity of cytology, inconsistent adherence to F/U recommendations, and insufficient availability of HRA. Improved communication of HIV-care-providers with all involved parties will be a key requirement for improving efficiency and outcomes.