Diagnostic Pathways for Anal Dysplasia in Men Living With HIV at a Single Urban HIV Center: A 30-Year Review

Précis: Prior to the implementation of standardized screening guidance, multiple diagnostic entry pathways identified anal dysplasia in MSM living with HIV. Objective: To describe diagnostic pathways leading to anal dysplasia identification in men who have sex with men (MSM) living with HIV over a 30-year period, before standardized anal cancer screening guideline implementation. Materials and Methods: This longitudinal retrospective cohort study included cisgender men who have sex with men (MSM) living with HIV who received care at an urban HIV clinic from January 1, 1993, through December 31, 2023. A comprehensive manual electronic medical record review identified documented cases of anal dysplasia. Participants were categorized by diagnostic entry pathway: cytology-first, direct diagnostic evaluation without preceding cytology, or incidental detection during unrelated procedures. Demographic and clinical characteristics were described. Results: Among 347 eligible participants, 47 (13.5%) had documented anal dysplasia. Of these, 25 (53%) were identified through direct diagnostic evaluation, 17 (36%) following anal cytology, and 5 (11%) incidentally. Demographic and HIV-related clinical characteristics did not differ significantly between the cytology-first and direct diagnostic evaluation groups. Among participants in the cytology-first group, 15 (88%) had abnormal cytology results; of these, 9 (60%) completed follow-up evaluation with colorectal surgery, including 7 (78%) within 1 year. Limitations include retrospective design, single-center setting, and incomplete documentation. Conclusions: Before standardized screening guidance, anal dysplasia in HIV-positive MSM was identified through multiple diagnostic entry pathways. These findings establish a baseline for evaluating future implementation of guideline-concordant screening in HIV care settings.