Prevention and management strategies of anal squamous cell carcinoma among men who have sex with men living with HIV

Abstract

The incidence of anal squamous cell carcinoma (SCCA) has been rapidly increasing in recent years. The burden of the disease is expected to increase in the forthcoming years. Men who have sex with men living with HIV (MSMLWH) have a higher incidence of SCCA than the general population. The progression of SCCA usually develops from high risk human papillomavirus (HR-HPV) infection to high grade squamous intra-epithelial lesions (HSIL). HPV infection is highly prevalent in MSMLWH and is considered the most important risk factor for SCCA in MSMLWH. Although the prevalence worldwide is largely similar, the distribution of high-risk HPV genotypes varies. Education on sexuality and lifestyle, use of condoms, fixed sexual partner, effective antiretroviral therapy (ART), smoking cessation, and preventive male circumcision could reduce HPV infection in MSMLWH. Screening and treatment of HSIL have been widely applied to prevent SCCA, but divergence still exists in many studies. When treating HSIL, patients of different ages and risk factors need more consideration to develop standardized management strategies, especially for MSMLWH. Very few studies have examined the treatment of SCCA with MSMLWH. ART has dramatically changed the treatment of SCCA in MSMLWH. The safety and outcome of treatment are still primary concerns for MSMLWH. More studies in this field are necessary to develop treatment strategies for MSMLWH.