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HPV-Related Anal Cancer — SCE Infectious Diseases MCQ

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ModerateHIV MedicineHPV-Related Anal CancerSCE Infectious Diseases

A 30-year-old man with HIV (CD4 70) presents with a large, fungating perianal mass. Biopsy shows invasive squamous cell carcinoma positive for HPV 16. What is the relationship between HIV, HPV, and this malignancy?

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Correct answer: D — HIV-associated immunosuppression allows persistent high-risk HPV infection, leading to progressive intraepithelial neoplasia and invasive carcinoma

HIV-associated immunosuppression impairs HPV clearance, allowing persistent high-risk HPV infection (particularly HPV 16 and 18) of the anal canal. This leads to a stepwise progression from anal intraepithelial neoplasia (AIN) grades 1–3 to invasive anal squamous cell carcinoma. MSM with HIV have the highest rates of anal cancer of any demographic. The ANCHOR trial demonstrated that treating high-grade AIN reduces progression to cancer. HPV vaccination can prevent new infections but does not treat existing HPV-related dysplasia.

Reference: BHIVA 2022 – HIV-associated malignancy; ANCHOR Trial 2022 – Lancet