Anal HPV Surveillance — SCE Infectious Diseases MCQ

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ModerateHIV MedicineAnal HPV SurveillanceSCE Infectious Diseases

A 30-year-old man with HIV (CD4 500, VL <50 on ART for 5 years) has a normal anal cytology but is HPV 16 positive on anal sampling. What surveillance schedule is recommended?

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Correct answer: D — Annual digital anorectal examination and anal cytology; consider high-resolution anoscopy referral if cytology becomes abnormal

HPV 16 positivity in an HIV-positive MSM, even with normal cytology, warrants annual surveillance because: (1) progression from normal to AIN2/3 occurs at a higher rate in PLWH than the general population, (2) cytology can miss early lesions (sensitivity ~50–70%), and (3) the ANCHOR trial demonstrated benefit of treating AIN2/3 when detected. BHIVA recommends annual digital anorectal examination (DARE) and annual anal cytology for MSM with HIV. If cytology becomes abnormal (ASC-US or worse), referral for high-resolution anoscopy (HRA) is indicated.

Reference: BHIVA 2022 – Anal cancer screening; ANCHOR Trial 2022