New national guidelines for anal cancer prevention in HIV patients based on UCSF research

New national guidelines for anal cancer prevention in HIV patients based on UCSF research

New recommendations for screening and treatment are based on the results of an important national study conducted at UCSF.

The results of a national study led by UC San Francisco informed the first federal guidelines in the United States to detect and treat anal cancer precursor lesions in people with HIV to reduce the risk of anal cancer.

The guidelines were released July 9 by a panel of experts in HIV care, using results from the Anal Cancer/HSIL Outcomes Research (Anchor) study led by Joel M. Palefsky, MD, a professor of medicine in the UCSF Division of Infectious Diseases. The anchor study was funded by the National Cancer Institute (NCI) of the National Institutes of Health NIH and conducted by the AIDS Malignancy Consortium.

The anchor study conducted at 25 clinical sites across the country and published in theNew England Journal of MedicineIn 2022, it was found that routine screening for and removal of precancerous anal lesions could significantly reduce the risk of anal cancer, thereby preventing cervical cancer in women.

“Anal cancer is a very bad disease, and we now have the tools to significantly reduce the risk,” said Palefsky, a world-renowned expert on anal cancer. “With this new recommendation, we hope that anal cancer screening will become a routine care procedure for people living with HIV.”

The risk of anal cancer is high in people with HIV

While anal cancer is rare within the general population, cases have been increasing and it is the fourth most common cancer among people living with HIV.

For people with human papillomavirus (HPV), a common sexually transmitted virus, co-infection with HIV may increase the risk of anal cancer. “Men with HIV who have sex with men and transgender women with HIV are the groups at highest risk of anal cancer,” note the new guidelines.

Anal cancer may have no symptoms in the early stages, and patients may mistake it for hemorrhoids. By the time it is diagnosed, it may have spread.

According to new guidelines released when high resolution becomes available, certain adults with HIV age 35 and older are for men and transgender women who have sex with men. and ages 45 and older for women and men who do not have sex with men—should screen for anal cancer precursor lesions with laboratory testing of an anal litter sample and a digital anorectal exam to sense changes that may indicate the presence of a cancer.

The screening process is quite simple. If the screening test is positive, the next step of evaluation is HRA. If HRA has a precursor to anal cancer, it will be treated to reduce the risk of it progressing to cancer. “

Joel M. Palfsky, MD, Professor of Medicine, Division of Infectious Diseases UCSF

If HRA is not available, people with HIV who are of screening age should continue to have an annual rectal exam and be referred for standard anoscopy if the screen is positive. Those who have pain, bleeding, masses, or show signs of anal cancer should undergo a standard anoscopy. Paläfsky added that symptomatic people under 35 with HIV should also undergo a standard anoscopy.

“I strongly encourage people living with HIV to discuss anal cancer screening with their primary care providers,” he said.

In 1991, Palefsky established the world's first clinic focused on anal cancer prevention, the UCSF Anal Neoplasia Clinic Clinic Research and Education Center.

The recommendations were developed by the U.S. Department of Health and Human Services on the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents Living with HIV, composed of experts in HIV care. The panel is a working group of the NIH Office of AIDS Research Advisory Council in collaboration with the Centers for Disease Control and Prevention, the HIV Medicine Association and the Infectious Diseases Society of America.

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