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Anal Pap Screening Recommended for Routine HIV Care

Anal Pap Screening Recommended for Routine HIV Care

The practice of routine anal Pap screenings as part of HIV care is being considered after US researchers determined, as published in the latest edition of AIDS Patient Care and STDs, that the procedure is both appropriate and feasible for early detection of pre-cancerous cells.

HIV-infected people appear to be at a much higher risk of anal cancer, many cases of which result from infection with the human papillomavirus or HPV, but they are not routinely screened. It is hoped that by changing this rates will fall similar to how rates of cervical cancer fell after routine screening was introduced.

As in the case with all cancers, early detection of pre-cancerous cells can dramatically improve treatment and survival outlooks.

From aidsmap
:

Abnormal anal cells were detected in 53% of patients. A low CD4 cell count was associated with abnormal cytology, but there was no relationship with anal intercourse.

“Our study is in concordance with other studies showing that anal precancerous lesions are commonly found in HIV-infected individuals,” comment the investigators.

[...]

Investigators from the Department of Veteran’s Affairs in Miami, Florida, wished to see if an anal Pap screening programme would be acceptable to their patients. They also wanted to establish the prevalence and risk factors for pre-cancerous cell changes.

The study was conducted between February and July 2006. A total of 160 patients were invited to participate in the research, and 131 (82%) agreed. All were men. These patients had a median age of 49 years, 52% were black and 60% denied any history of anal intercourse.

[...]

Over half (53%) of the patients with adequate samples had abnormal anal cytology, and 37% of these individuals had low-grade pre-cancerous cell changes, with a further 5% having high-grade changes.

After controlling for potential confounders, a low CD4 cell count was the only factor significantly associated with abnormal anal cytology (p = 0.026).

A total of 33 patients with abnormal cytology had further investigations including high-resolution anoscopy and biopsy. These examinations confirmed the presence of pre-cancerous lesions in all but two of the patients. Moreover, anal cancer was detected in two individuals.

[Read more at aidsmap.]

The study showed a higher than expected rate of failed tests, a majority of which were put down to those administering the tests not doing so correctly, highlighting that, as with all new or relatively uncommon procedures, training will be paramount in ensuring viable test samples. Investigators also noted the problem of men self-reporting sexual activity.

Clinicians usually recommend that men who have sex with men, people who have HIV and those that have suffered from anal warts all get screened, however there exists no standard common practice for this, so introducing screenings as a part of regular HIV care practice would be a proactive step forward.

An anal Pap screening is usually carried out in much the same way as a cervical smear is undertaken but without need for the use of a speculum or anoscope. A small polyester Dacron swab is used to collect cell samples from the anal canal by swabbing the surfaces of the anus and rectum. Samples are then reviewed at a lab and a physician should be able to give the results of the screening within a few days. To find out more, please click here.

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Photo used under the Creative Commons Attribution License, with thanks to Stully Pixel.

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18 comments

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7:34AM PDT on Apr 25, 2011

Thanks for sharing.

7:21AM PDT on Apr 25, 2011

THANK YOU

7:58PM PDT on Apr 24, 2011

one more annual test that will save your life!!

11:00AM PDT on Apr 24, 2011

Based on what you said, it makes sense.

7:22AM PDT on Apr 24, 2011

Thank you for sharing this article with us. However, what the value of a human life ever boils down to is the ALMIGHTY DOLLAR in our society. To mankind it is often considered a crime & punishment issue, I mean that if you have HIV/AIDS or gay you definitely brought this on yourself and why bother your going to die anyway. It's 30 years later & mankind's mentality pretty much is still the same.

Doctor's already provide less than good care b/c of payment from insurance companies--I call it 'The 5 minute touch & go". So you want them to take the time to do something that they promised to do--which is to save human lives. What does that mean? That means view us as more than a number, insurance, or disease WE ARE HUMAN BEINGS.

I believe that doing this simple test & making it part of an exam to screen for cancer should be done. See I'm not a provincial minded individual. I guess that I'M STILL HUMAN & MANY IN THE HEALTHCARE BUSINESS AREN'T QUITE HUMAN.

Please show us that the patient & their lives matter.

1:19AM PDT on Apr 24, 2011

Thanks for the article.

12:46AM PDT on Apr 24, 2011

I'm living w/ HIV+ for 2 years. It feels like the life I had ahead of me was ripped away. My friend told me an STD support site STDdatings,com..only for those w/ herpes,HIV,HPV or other STDs..no rejection or discrimination..i've got lots of help. most important, find hope again.

8:40PM PDT on Apr 23, 2011

I must mention, I made my comment with the utmost respect to the Gay Communities.
I was simply "giving it as it is" so to speak.
We all know that the straight "male" community will run a rugged mile to avoid having anything to do with having a test that "gay guys have".
I know it sounds offensive and it is not meant to be, I was simply showing one of the greatest hurdles in testing across the board with all males. If you package it well you will have more men take up the chance to be tested. Doesn't mean I in any way agree with that line of thought, it is just stating a fact from the book of male myths.

8:29PM PDT on Apr 23, 2011

A good move to help prevent or give earlier diagnosis of a disease that is killing large numbers of men daily. The interesting thing here is nobody is mentioning... YOU CAN GET ANAL CANCER IN YOUR EARLY TO MID TWENTIES, you DON'T have to be some old guy on a pension. It affects many people in many different ways. It doesn't always mean the recipient had anal sex... it could be dietary or genetic. Whichever the case, I imagine you would rather an early warning than suffer the alternative.
Found a NEW way to detect Cancer..........DO IT!! that should be the only comment.
The reason this is getting so much "Air time" is that is we are talking about the "Bum" and someone has thrown in the "Gay Grenade" that seems to ignite public debate.
Revert to my original statement, being:
Found a New way to Detect Cancer ..........DO IT!!
Should just forget all the hysteria of anything being Gay related and just get on with treating this as a Male Disease. You may get more men turning up for voluntary testing if you did.

11:13AM PDT on Apr 23, 2011

Our government re-creates the AIDS virus and targets certain avenues for it to be spread, in order to ultimately thin out the population.. and allows Big Pharma to charge astronomical prices for the meds that will actually cause AIDS in someone who is HIV+...... all the time claiming to have this so-called "war on AIDS".... just like the "war on DRUGS"... and the "war on TERRORISM".......... all a bunch of overly-propagandized BS! And costing Americans billions (trillions?) in wasted tax-dollars.. while we have people who don't have a clue as to when they'll receive their next meal. Sad case indeed!

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