Introduction There is a rising incidence of anal cancer and pre-cancer among people living with HIV (PLWH), largely thought to be driven by sexual transmission of the Human Papilloma virus. However, a wide difference in screening methods exists. BHIVA guidelines state centres should incorporate a pathway of managing suspected peri-anal and anal cancers and pre-cancers.
Methods Our aim was to collate data on current screening and referral methods for peri-anal and anal lesions within our region to guide establishing a regional management pathway.
An online survey was sent to specialists involved in managing PLWH. This included trainees and Consultants in Infectious Disease and Genito-urinary medicine. They were asked the methods used, if any, in routine clinics for identifying PLWH with anal and peri-anal cancers and pre-cancers, and whether there was a local established management pathway.
Results 33% of respondents stated that they regularly screened PLWH for peri-anal and anal lesions; the majority by enquiring about symptoms or carrying out proctoscopy examination, largely in men who have sex with men and PLWH with known anogenital warts. Only one Infectious Diseases specialist felt comfortable in using a proctoscope, and 67% of clinicians did not feel that they could be involved in the annual surveillance of peri-anal and anal intra-epithelial neoplasia.
Discussion The results have supported the need for the implementation of a peri-anal and anal cancer and pre-cancer management pathway within our HIV regional network, alongside further education and streamlining of screening within the region.
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