Anal Fissure in HIV Standard — SCE Infectious Diseases MCQ

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EasyHIV MedicineAnal Fissure in HIV StandardSCE Infectious Diseases

A 30-year-old man with HIV develops an anal fissure. He is MSM and has well-controlled HIV (CD4 620, VL <50). His GP asks whether the anal fissure management differs in HIV. What is the advice?

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Correct answer: C — Standard anal fissure management applies — GTN 0.4% ointment BD for 6–8 weeks first-line; dietary modification (fibre, fluids); surgical referral if refractory; HIV status does not alter management at this CD4

In well-controlled HIV (CD4 >200, suppressed VL), anal fissure management follows identical guidelines to HIV-negative patients. GTN 0.4% topical ointment is first-line (relaxes the internal sphincter, improves blood flow). Alternatives: topical Diltiazem 2%. If refractory after 6–8 weeks, botulinum toxin injection or lateral internal sphincterotomy may be considered. Importantly, persistent or atypical anal fissures in HIV/MSM should prompt consideration of: syphilitic chancre, HSV ulceration, anal cancer, or Crohn disease — but a classic acute midline fissure is managed standardly.

Reference: NICE CKS 2024 – Anal fissure; BHIVA 2022 – Anorectal conditions