German‐Austrian guideline on screening for anal dysplasia and anal carcinoma in people living with HIV

People with HIV are up to 100 times more likely to develop anal carcinoma compared to the general population. Diagnosing and treating precursor lesions, specifically high-grade anal dysplasia, can significantly reduce the risk of developing anal carcinoma. This S2k-guideline outlines the factors that increase the likelihood of developing anal carcinoma and its precursors, including advancing age, a low CD4<sup>+</sup> T-lymphocyte nadir, active cigarette smoking, receptive anal intercourse, or persistent infection with high-risk (HR) types of human papillomavirus (HPV). Screening is primarily recommended for all men who have sex with men (MSM) and transgender women with HIV starting at age 35, and all people with HIV starting at age 45. After inspection and digital anorectal examination, anal cytology is collected. An HR-HPV test may be performed. If clinical abnormalities are present or if cytology shows "ASC-US or worse", a referral for high-resolution anoscopy (HRA) is indicated. If lesions are found during HRA, a biopsy should be obtained. Anal intraepithelial neoplasia (AIN) grade-III or AIN-II p16-positive correspond to high-grade dysplasia and require treatment. The most strongly recommended therapeutic options are electrocautery, 85% trichloroacetic acid, and surgical excision. Finally, the guideline discusses how these screening recommendations can be applied to individuals without HIV.

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Publication Details

Journal
JDDG Journal der Deutschen Dermatologischen Gesellschaft
Published
2025-05-05
DOI
https://doi.org/10.1111/ddg.15719
Citations
5
Primary Topic
Cervical Cancer and HPV Research
Type
article
Field-Weighted Citation Impact
6.77
Controls
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article

German‐Austrian guideline on screening for anal dysplasia and anal carcinoma in people living with HIV

Felix Aigner, Elmar A. Joura, Johannes Jongen, Andreas Salat et al.
5 citations
JDDG Journal der Deutschen Dermatologischen Gesellschaft
Cervical Cancer and HPV Research
6.77
article

German‐Austrian guideline on screening for anal dysplasia and anal carcinoma in people living with HIV

Felix Aigner, Elmar A. Joura, Johannes Jongen, Andreas Salat, Markus Bickel, Georg Stary, Monika Hampl, Ulrike Wieland, Mark Oette, Marcus Hentrich, Gerhard Weyandt, Frank Oellig, Reinhard Kirnbauer, Gerold Felician Lang, Andrea Brunner, Doris Helbig, David Chromy, Christian Pieter Hoffmann, Jürgen Christian Becker, Axel Jeremias Schmidt, Andreas D. Rink, Alexander Kreuter, Anja Potthoff, Ricardo Niklas Werner, Robert Siegel, Johannes Claßen, Franc Hetzer, Memo Mokhles, Stefan Essern
article en
5 citations

Abstract

People with HIV are up to 100 times more likely to develop anal carcinoma compared to the general population. Diagnosing and treating precursor lesions, specifically high-grade anal dysplasia, can significantly reduce the risk of developing anal carcinoma. This S2k-guideline outlines the factors that increase the likelihood of developing anal carcinoma and its precursors, including advancing age, a low CD4<sup>+</sup> T-lymphocyte nadir, active cigarette smoking, receptive anal intercourse, or persistent infection with high-risk (HR) types of human papillomavirus (HPV). Screening is primarily recommended for all men who have sex with men (MSM) and transgender women with HIV starting at age 35, and all people with HIV starting at age 45. After inspection and digital anorectal examination, anal cytology is collected. An HR-HPV test may be performed. If clinical abnormalities are present or if cytology shows "ASC-US or worse", a referral for high-resolution anoscopy (HRA) is indicated. If lesions are found during HRA, a biopsy should be obtained. Anal intraepithelial neoplasia (AIN) grade-III or AIN-II p16-positive correspond to high-grade dysplasia and require treatment. The most strongly recommended therapeutic options are electrocautery, 85% trichloroacetic acid, and surgical excision. Finally, the guideline discusses how these screening recommendations can be applied to individuals without HIV.

JDDG Journal der Deutschen Dermatologischen GesellschaftVol. 23(8)
Goethe University Frankfurt (DE), German Cancer Research Center (DE), University of Cologne (DE), Heidelberg University (DE), Royal Society of Tropical Medicine and Hygiene (GB), German Red Cross (DE), University Hospital Heidelberg (DE), Bayreuth Medical Center (DE), Humboldt-Universität zu Berlin (DE), Düsseldorf University Hospital (DE), London School of Hygiene & Tropical Medicine (GB), Hirslanden Klinik Im Park (CH), Krankenhaus vom Roten Kreuz (DE), Krankenhaus der Augustinerinnen (DE), St. Vincentius-Kliniken (DE), Infektionsmedizinisches Centrum Hamburg (DE), Essen University Hospital (DE), HELIOS St. Elisabeth Klinik Oberhausen (DE), Ruhr West University of Applied Sciences (DE), Hospital of the Brothers of St. John of God (AT), University Hospital Frankfurt (DE), St. Josef-Hospital (DE), Kompetente Werthaltige Ingenieurleistung (Austria) (AT), University Hospital Cologne (DE), Deutsches Konsortium für Translationale Krebsforschung (DE), Heinrich Heine University Düsseldorf (DE), Freie Universität Berlin (DE), Medical University of Vienna (AT), Charité - Universitätsmedizin Berlin (DE)
Good health and well-being
Openalex Percentile: Top 3%
Cervical Cancer and HPV Research
6.77
DOIOpen Access PDFOpenAlex
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