ArticleInfection2026
Challenges and limitations of anal cancer and precancer screening among people with HIV in a real-world setting.
Article in Infection, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Noninvasive Sampling Reveals Distinct Human Papillomavirus and Immune Signatures Associated With Cytological Abnormalities in People Living With HIV-1.Open forum infectious diseases · 2026Article
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Authors and funding
7 authors.
Funding
Abstract
purposeAnal carcinoma (AC) incidence in people with HIV (PWH) is increasing. Guideline-recommended anal-cytology screening facilitates early treatment of precancerous lesions. Data on real-world adherence to screening- and follow-up (F/U)-recommendations remain limited.
methodsWe analyzed routine anal-cytology screening in PWH at a German university hospital-clinic (2017-2023), including frequency of findings, F/U, and final diagnoses.
resultsThe study-population included 434 persons with 936 anal-cytology results, representing 25% of person-time of F/U at our clinic. Median age was 55 years, female/male ratio was 5/429, 310 (71%) were MSM. Median CD4-nadir was 242/µl, in 97% viral load was suppressed, 47% were currently smoking. Of 936 swab-results, 882 (94%) were evaluable; 201 (21%) showed abnormalities. Among these, 60 (30%) were ASC-US, 77 (38%) LSIL, 12 (6%) ASC-H, and 52 (26%) HSIL. High-resolution-anoscopy (HRA), recommended for the 64 ASC-H/HSIL-cases, was performed in 7 (11%), identifying 1 AIN2. In 46/64 (72%) proctoscopy identified 1 AC and 3 cases each of AIN2/AIN3. Eleven persons (17%) refused F/U. Thus, 8/64 (12.5%) suspicious cytology findings were histopathologically confirmed. During the study period, 4 cases of AC were diagnosed in unscreened persons at our clinic.
conclusionRoutine anal-cytology screening in an unsystematically selected cohort of 434 PWH contributing 1,383 person-years of F/U identified 7 cases of high-grade precancerous lesions and 1 asymptomatic AC. Important challenges included low uptake, limited specificity of cytology, inconsistent adherence to F/U recommendations, and insufficient availability of HRA. Improved communication of HIV-care-providers with all involved parties will be a key requirement for improving efficiency and outcomes.
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