Clinical Question

Does early treatment of screen-detected anal high-grade squamous intraepithelial lesions in patients living with HIV reduce the likelihood of progression to invasive anal cancer compared with active surveillance?

Bottom Line

Immediate treatment of screen-detected anal high-grade squamous intraepithelial lesions reduces the likelihood of progression to invasive anal cancer (number needed to treat = 111 over 26 months). The study was not powered to detect a reduction in mortality. (Level of Evidence = 1b)

Synopsis

People with HIV are at the highest risk of anal cancer. Although not addressed by the U.S. Preventive Services Task Force, some clinicians recommend screening for anal cancer in this group using liquid-based anal cytology (similar to screening for cervical cancer) and high-resolution anoscopy. The study invited people 35 years and older with HIV to receive anal cancer screening. The median age was 51 years, 78% were men, and 42% were Black. Groups were balanced at the start of the study, and analysis was by intention to treat. Of 10,723 people who were screened, 4,459 were given a diagnosis of anal high-grade squamous intraepithelial lesions and were randomized to receive immediate treatment or active surveillance.