HPV and Anal Cancer in HIV-Infected Individuals: A Review
HIV infection is one of the strongest risk factors for anal squamous cell cancer (ASCC). Most ASCC are caused by HPV, and most HPV-associated ASCC are caused by HPV-16. Anal HPV infections are very common in men who have sex with men (MSM), and nearly universal among HIV-infected MSM. High-grade anal intraepithelial neoplasia (HGAIN), the precursor for ASCC, is present in about 30 % of HIV+ MSM, but neither the progression rate to ASCC nor the regression rate are known. The incidence rate of ASCC among HIV-infected people has risen in the first decade after cART became available, but appears to be plateauing recently. Anal cytology has poor sensitivity and specificity. High resolution anoscopy (HRA) is advocated by some as a screening tool in high-risk groups, but is cumbersome and time-consuming and it is unknown whether HRA followed by treatment of HGAIN prevents ASCC. More research is needed on progression and regression rates of HGAIN, on effective therapy of HGAIN, and on biomarkers that predict HGAIN or anal cancer. HPV vaccination and earlier start of cART may prevent most anal cancers in the long run.
KeywordsHIV HPV Anal cancer Men who have sex with men Risk factor Epidemiology Prevalence Incidence Treatment Review Screening Vaccine
SH Mooij is funded through a grant from Aids Fonds (grant number 2009029) and additional funding from the Public Health Service Amsterdam. The authors would like to thank Eric Vos, Catharina Alberts, and Nora Verbauwen (GGD Amsterdam) for assistance in finding and organizing the literature.
All authors contributed to the literature search. Maarten F. Schim van der Loeff wrote the first draft. All authors contributed to subsequent versions and saw and approved the final version.
Maarten F. Schim van der Loeff received funding for a study on oral HPV from Sanofi-Pasteur MSD, participates in a Merck-funded investigator-initiated study on Gardasil, and is principal investigator in a Merck-sponsored study on a nonavalent HPV vaccine. Jan M. Prins and Henry J. C. de Vries are principal investigators in 2 studies sponsored by The Netherlands Organisation for Scientific Research (NWO), investigating therapeutic and prophylactic HPV vaccination in HIV+ MSM. Henry J. C. de Vries is an investigator on a Merck-sponsored study on a nonavalent HPV vaccine.
Compliance with Ethics Guidelines
Conflict of Interest
Maarten F. Schim van der Loeff reports grants from Merck, Sanofi-Pasteur-MSD, and Sanofi-Pasteur-MSD for outside the submitted work. Henry J. C de Vries reports personal fees from Willpharma, Ministry of Defence, Abvie, and Benecke for outside the submitted work. Jan M. Prins reports grants from The Netherlands Organisation for Scientific Research (NWO) for outside the submitted work. Sofie H. Mooij and Oliver Richel declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Sofie H. Mooij is employed at GGD Amsterdam through a grant from the AIDS Funds (grant number 2009029). For this review no other funding was obtained.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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