ANAL cancer screening in people with HIV (PWH) is entering a new era, following major advances in evidence and recent guideline updates that aim to reduce cancer burden in this high-risk group. A newly published state-of-the-art review presents a comprehensive framework for clinicians navigating evolving recommendations.
Although anal cancer remains relatively uncommon in the general U.S. population, with around 10,000 cases annually, PWH, especially men who have sex with men, face a dramatically higher risk. In some subgroups, the risk may be more than 100 times that of the general population. Historically, screening protocols varied widely due to a lack of high-quality evidence. The 2020 U.S. HIVMA guidelines recommended screening only for select individuals, and only if high-resolution anoscopy was accessible.
This changed with the 2022 ANCHOR randomized controlled trial, which demonstrated that treating high-grade squamous intraepithelial lesions (HSIL), a precancerous condition, significantly reduced progression to anal cancer. The findings catalyzed the publication of two major guideline sets in 2024: the International Anal Neoplasia Society’s consensus recommendations and the U.S. Department of Health and Human Services Opportunistic Infections Panel guidance specific to PWH.
The review synthesizes these developments to support clinical decision making. Using a clinical vignette, the authors outline how to assess risk, understand the pathogenesis of anal dysplasia, and apply current screening tools. They also emphasize prevention, including HPV vaccination and behavioral risk reduction. In addition, the review discusses how providers can establish anal dysplasia screening programs and contribute to further research in this rapidly developing area.
Given the substantial difference in cancer risk and the possibility of early intervention, these updates mark a pivotal shift in the standard of care for anal cancer prevention in PWH.
Reference:
Andrews HS et al. State-of-the-Art Review: Anal Cancer Screening in People With HIV. Clin Infect Dis. 2025;80(6):e80-e88.
