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Anale intraepitheliale Neoplasie und Analkarzinom

Ein zunehmendes Problem bei Menschen mit HIV-Infektion

Anal intraepithelial neoplasia and anal carcinoma

An increasing problem in HIV patients

Zusammenfassung

Anale Dysplasien sind häufig bei HIV-Infizierten, besonders bei HIV-positiven Männern die Sex mit Männern (MSM) haben. Hochgradige Dysplasien können in invasive Analkarzinome übergehen. Wie beim Zervixkarzinom besteht auch beim Analkarzinom eine kausale Assoziation zu Infektionen mit humanen Papillomviren (HPV), insbesondere mit Hochrisikotypen wie HPV16. Von Experten werden für das Analkarzinom Vorsorgeuntersuchungen mittels Analzytologie vorgeschlagen. Die klinische Untersuchung, probebioptische Sicherung und Therapie analer Dysplasien erfolgt mittels hochauflösender Anoskopie. Analkarzinome werden in Analrandkarzinome und Analkanalkarzinome unterteilt. Analrandkarzinome früher Stadien werden wie Plattenepithelkarzinome der exponierten Haut primär chirurgisch exzidiert, während Analkanalkarzinome mit kombinierter Radiochemotherapie behandelt werden. HIV-positive haben eine vergleichbares Ansprechen auf die kombinierte Radiochemotherapie wie HIV-negative Personen, HIV-Positive haben jedoch deutlich schwerere Nebenwirkungen, insbesondere akute toxische Hautschäden durch die Radiatio, frühere Rezidive und damit verbunden höhere Raten an abdominoperianalen Rektumamputationen. Im Bereich HIV/AIDS tätige Ärzte sollten HIV-infizierte MSM regelmäßig auf das Vorliegen von analen Dysplasien und Analkarzinomen untersuchen. Basisdiagnostik ist neben der klinischen Inspektion der Perianalregion die digitale rektale Untersuchung und Analzytologie.

Abstract

Anal dysplasia is common in HIV patients, especially in HIV-positive men having sex with men (MSM). High-grade anal dysplasia can progress to invasive anal cancer. As in cervical carcinoma, there is a cause and effect relationship between anal cancer and human papillomavirus (HPV) infection, especially with high-risk types such as HPV16. Several experts have recommended screening programs for anal cancer, including anal cytology along the lines of the Pap smear in women. Such screenings should only be performed if pathological findings result in further diagnostic steps and, if necessary, appropriate treatment. Clinical inspection, lesion biopsy, and treatment of anal dysplasia are performed under high-resolution anoscopy. Anal cancer is divided into cancer of the anal margin and cancer of the anal canal. This classification is important because of the difference in treatment regimens. Early cancer of the anal margin is excised akin to squamous cell cancer of the exposed skin, whereas cancer of the anal canal is treated by radiochemotherapy. HIV-positive and HIV-negative patients have similar response rates to combined radiochemotherapy. However, side effects, especially acute post-irradiation skin toxicity, early local recurrences, and abdominoperineal rectal excision are more common in HIV-positive patients. Physicians working in the field of HIV/AIDS should regularly screen their patients for the presence of anal dysplasia and anal cancer. Basic diagnostic workup includes clinical inspection of the perianal area, digital rectal examination, and anal cytology.

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Correspondence to A. Kreuter.

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Der Beitrag wurde vom deutschen Kompetenznetz HIV/AIDS gefördert.

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Kreuter, A., Brockmeyer, N. & Wieland, U. Anale intraepitheliale Neoplasie und Analkarzinom. Hautarzt 61, 21–26 (2010). https://doi.org/10.1007/s00105-009-1810-5

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Schlüsselwörter

  • Anale intraepitheliale Neoplasie
  • Analkarzinom
  • HIV-Infektion
  • Humanes Papillomvirus
  • Anoskopie

Keywords

  • Anal intraepithelial neoplasia
  • Anal cancer
  • HIV infection
  • Human papillomavirus
  • Anoscopy