Anal intraepithelial neoplasia and squamous cell carcinoma in HIV-infected adults

HIV Med. 2014 Feb;15(2):65-76. doi: 10.1111/hiv.12080. Epub 2013 Sep 6.


Anal cancer is one of the most common non-AIDS-defining malignancies in the era of combination antiretroviral therapy. Its precursor lesion, anal intraepithelial neoplasia (AIN), is highly prevalent in HIV-infected populations. More than 90% of anal squamous cell cancers are attributable to human papillomavirus (HPV). While the biology of HPV-related intraepithelial neoplasia is consistent across lower anogenital sites, the natural history of AIN is not well established and cannot be assumed to be identical to that of cervical intraepithelial neoplasia. Screening strategies to prevent anal cancer should be developed based on robust natural history data in HIV-infected and uninfected populations. Likewise, treatments need to be tested in randomized clinical trials, and reserved for those at significant risk of progression to cancer. This review covers the epidemiology, pathogenesis and immunology of HPV infection, AIN and anal cancer, and summarizes the current diagnosis, screening and treatment strategies in HIV-infected adults.

Keywords: HIV; anal canal; anal cancer; human papillomavirus; intraepithelial neoplasia.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anus Neoplasms / diagnosis
  • Anus Neoplasms / epidemiology
  • Anus Neoplasms / etiology*
  • Carcinoma in Situ / diagnosis
  • Carcinoma in Situ / epidemiology
  • Carcinoma in Situ / etiology*
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / epidemiology
  • Carcinoma, Squamous Cell / etiology*
  • HIV Infections / complications*
  • Humans
  • Papillomavirus Infections / epidemiology
  • Papillomavirus Infections / immunology
  • Papillomavirus Infections / prevention & control
  • Papillomavirus Vaccines / administration & dosage
  • Risk Factors


  • Papillomavirus Vaccines