Screening for anal dysplasia associated with human papillomavirus

Anal dysplasia associated with human papillomavirus (HPV) infection occurs in substantial proportions of HIV-infected men and women and poses risk for anal carcinoma. Whether to routinely screen for HPV-associated anal dysplasia in this population, however, remains a debated question. Anal dysplasia is detectable by Pap screening and colposcopic biopsy; as Pap testing results have relatively low reproducibility, 2 baseline tests may be prudent. Screening should also ascertain risk factors for dysplasia, degree of immunosuppression, and history of prior anal disease. Although treatment options for anal dysplasia are limited by morbidity and high recurrence rates, early detection may permit better tolerance of therapy, and current estimates indicate that routine screening for the condition would be cost-effective. In addition, emerging immunologic therapies offer hope of more effective future treatment. This article summarizes a presentation given by Wm. Christopher Mathews, MD, MSPH, at the November 2002 International AIDS Society-USA course in San Diego.