From the Guidelines
A patient with a history of high-grade anal dysplasia who underwent condyloma excision 3 years ago should continue regular anal Pap smears for surveillance, typically every 6-12 months, to monitor for recurrence or progression of disease. The purpose of ongoing screening is to monitor for recurrence or progression of disease, as patients with previous high-grade dysplasia remain at elevated risk for developing anal cancer, as noted in the 2018 NCCN clinical practice guidelines in oncology 1. Human papillomavirus (HPV), which causes condyloma and dysplasia, can persist in the anal mucosa even after visible lesions are removed, potentially leading to new dysplastic changes over time. According to the 2018 guidelines, PLWH are at higher risk of premalignant anal epithelial changes compared to HIV-negative patients, and many HIV specialists do screen PLWH for dysplasia by anal cytology, high resolution anoscopy, and annual digital anal exam 1.
Key Considerations
- The screening protocol may eventually be adjusted based on consecutive negative results, but this should be determined by a specialist familiar with the patient's specific risk factors, including immune status, HPV status, and the completeness of the original excision.
- Patients should be advised to report any new symptoms promptly, such as bleeding, pain, or visible lesions, as these may warrant immediate evaluation regardless of the scheduled screening interval.
- Treatment of anal dysplasia in PLWH is associated with a higher risk of recurrence in PLWH compared to HIV-negative patients, highlighting the importance of regular surveillance 1.
Surveillance and Screening
- Anal cytology, high resolution anoscopy, and annual digital anal exam are commonly used methods for screening PLWH for dysplasia.
- If high-grade anal squamous intraepithelial lesions (high-grade anal intraepithelial neoplasia [AIN]) are identified, then high-resolution anoscopy should be performed, if available 1.
From the Research
Anal Dysplasia Screening and Treatment
- The patient in question has a history of high-grade anal dysplasia and underwent condyloma excision 3 years ago, which puts them at a higher risk for anal cancer 2, 3.
- Studies have shown that patients with a history of high-grade dysplasia are at a higher risk for recurrence and should undergo regular screening 4.
- The American Society for Colposcopy and Cervical Pathology recommends annual anal Pap testing for individuals with a history of high-grade anal dysplasia 3.
- High-resolution anoscopy (HRA) is a diagnostic tool used to visualize the anal canal and identify abnormal lesions, and is recommended for patients with abnormal anal Pap test results or a history of high-grade dysplasia 2, 3.
- Treatment options for high-grade anal intraepithelial neoplasia (HGAIN) include ablation with infrared coagulation, CO2 laser, or electrocautery, as well as topical treatments such as 5-fluorouracil or imiquimod 5.
- Regular follow-up and screening are crucial for patients with a history of high-grade anal dysplasia, as recurrence is common and can increase the risk of anal cancer 4.
Screening Recommendations
- Patients with a history of high-grade anal dysplasia should undergo regular anal Pap testing and HRA screening 2, 3.
- The frequency of screening should be determined by the patient's individual risk factors and medical history 3.
- Patients with a history of condyloma excision should also be screened for anal dysplasia, as they may be at a higher risk for recurrence 6.
Treatment and Follow-up
- Treatment of HGAIN should be individualized based on the patient's medical history, the extent and severity of the disease, and the patient's preferences 5.
- Regular follow-up and screening are crucial for patients with a history of high-grade anal dysplasia, as recurrence is common and can increase the risk of anal cancer 4.
- Patients should be educated on the importance of regular screening and follow-up, and should be encouraged to adhere to their recommended screening schedule 3.