Squamous Intraepithelial Lesion of the Anus in a Man With HIV Infection

Susan C. Ball, MD, MPH


AIDS Read. 2004;14(9) 

In This Article

Treatment and Prevention

Once dysplasia has become invasive disease, treatment is aggressive. Combined-modality treatment with chemotherapy and radiation is the current standard of care, with surgery (colostomy) used to treat recurrent or residual disease. Results are excellent, with 3-year survival rates as follows: overall, 86%; colostomy-free, 73%; and disease-free, 67% in one study, which used 5-FU and cisplatin with radiation.[15]

With anal cancer being considered a sexually transmitted disease, efforts at prevention need to be made. Efforts at screening for anal dysplasia have yet to become widely accepted or practiced. There are many similarities with cervical cancer, but prevention as yet is not one. Identifying those persons most at risk to target for screening is important.

Terry, a gay white man who has had many sexual partners over the years, has not always practiced safer sex, as he admits and as his history of syphilis infections attests. While he denies a history of genital warts, it is likely that he has been asymptomatically infected with HPV of varying types on repeated occasions. He is upset to be told of the potential for cancer from an infection that he never knew he had. He asks you whether his HIV infection has been a factor in the development of SIL and potentially of anal cancer.


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