Establishing an anal dysplasia clinic for HIV-infected men: initial experience

Anal dysplasia caused by human papillomavirus (HPV) infection is common in the HIV-infected population and is a precursor to squamous cell carcinoma of the anus (SCCA). Herein, we describe our initial experience in assessing the frequency and severity of anal intraepithelial neoplasia (AIN) in a newly formed anal dysplasia clinic in Seattle. During a 7-month period, 150 HIV-positive men were evaluated by digital rectal examination and high-resolution anoscopy (HRA). Forty-seven patients of the 122 patients who underwent biopsy (39%) had biopsy-identified low-grade AIN, and 47 (39%) had high-grade AIN (HGAIN). Two patients with HGAIN were referred for surgical treatment and were further noted to have microinvasive SCCA. No patient reported significant post-HRA biopsy complications. Patient tolerance and acceptance of AIN screening was good, and the majority of those who underwent screening have been adherent to recommended follow-up examinations and treatment. The clinic is expanding rapidly, with excellent community and provider support. We anticipate that the anal dysplasia clinic will enable our institution to participate in emerging HIV- and HPV-related AIN clinical trials.