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15 July 2006

Volume 43, Number 2
Clinical Infectious Diseases 2006;43:223–233
1058-4838/2006/4302-0016$15.00
DOI: 10.1086/505219
HIV/AIDS REVIEW ARTICLE

Screening HIV‐Infected Individuals for Anal Cancer Precursor Lesions: A Systematic Review

Elizabeth Y. Chiao,1,2

Thomas P. Giordano,1,2

Joel M. Palefsky,4

Stephen Tyring,3 and

Hashem El Serag1,2

1Baylor College of Medicine, 2Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center (152), and 3University of Texas Health Science Center at Houston, Houston, Texas; and 4University of California, San Francisco, San Francisco

Individuals with human immunodeficiency virus (HIV) infection are at increased risk for human papillomavirus–related squamous cell cancer of the anus. Screening HIV‐infected patients for squamous cell cancer of the anus and human papillomavirus–related anal dysplasia may prevent excess morbidity and mortality. We have conducted a systematic review of the indirect evidence in the literature regarding the utility of anal Papanicolau (Pap) smear screening of HIV‐infected individuals in the highly active antiretroviral therapy era. Although there are no published studies evaluating the efficacy of anal Pap smear screening for preventing squamous cell cancer of the anus or anal intraepithelial neoplasia, we reviewed data regarding the burden of disease, anal Pap smear sensitivity and specificity, the prevalence of anal dysplasia, and 1 cost effectiveness study. The available evidence demonstrates that HIV‐infected individuals have an increased risk for squamous cell cancer of the anus and anal intraepithelial neoplasia. This review identifies important areas for further study before routine anal Pap smear screening can be recommended.

Received 19 January 2006; accepted 20 March 2006; electronically published 7 June 2006.

Reprints or correspondence: Dr. Elizabeth Y. Chiao, Veterans Affairs Medical Center (152), 2002 Holcombe Blvd., Houston, TX 77030 ().

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