Alexander Kreuter


Department of Dermatology, Venereology, and Allergology, HELIOS St Elisabeth Hospital Oberhausen, University Witten/Herdecke, Germany

Human papillomavirus (HPV) infections belong to the most common sexually transmitted infections worldwide. While most HPV-infections in the general population are eliminated by the immune system within a short period of time, HPV-infection tends to persist in immunosuppressed individuals. In HIV-infected men who have sex with men (MSM), anal HPV-infection is almost always present and infections with multiple HPV types are common. HPV-associated anogenital malignancies occur with high frequency in these patients. Anal intraepithelial neoplasia (AIN), a potential precursor lesion of squamous cell carcinoma of the anus, is causally linked to persistent infections with high-risk HPV. Increasing evidence indicates that high grade lesions can progress to anal cancer over time. Anal cytology similar to cervix cytology has been recommended as the primary screening tool for anal dysplasia in the at-risk population. Individuals with abnormal cytology should undergo high resolution anoscopy to appropriately identify and treat dysplastic lesions. Treatment guidelines for AIN are still missing. Therapeutic strategies might be distinguished in topical (e.g. trichloroacetic acid, podophyllotoxin, imiquimod, photodynamic therapy) and ablative (e.g. surgical excision, laser ablation, infrared coagulation, electrocautery) interventions. Anal cancer has become one of the most common non-AIDS-defining tumours in HIV-infected individuals. In the era of highly active antiretroviral therapy, the outcome of combined chemoradiotherapy in HIV-positive individuals with anal cancer is similar to HIV-negative persons. Penile and oral HPV- associated diseases seem to be more frequent in HIV-positive MSM than reported for HIV-negative heterosexual men. Diagnostic and therapeutic guidelines should be implemented for at-risk populations for anal dysplasia/anal cancer such as HIV-positive MSM. More study is required to get better insights into the natural history of penile and oral HPV-associated benign and malignant lesions.  


34 IUSTI Congress - European Congres on Sexually transmitted Infections and HIV/AIDS
Bucharest, September 3-5,