Anal Cancer Screening Guidelines for PLHIV
Last updated: November 2024
Screening Intervals and Cessation
The IANS guidelines acknowledge that there is virtually no evidence available to determine appropriate screening intervals for those who test screen-negative17. The Australian National Cervical Screening Program established in 2017 uses primary HRHPV testing. In non-immunosuppressed individuals, 5-yearly re-screening is recommended in those who screen negative. For PLHIV 3 yearly re-screening is recommended in women who test HPV negative, (https://www.cancer.org.au/clinical-guidelines/cervical-cancer/cervical-cancer-screening). In the absence of specific evidence for anal cancer, we recommend a screening interval that is the same as for cervical cancer in PLHIV (i.e. 3-yearly). Re-screening is recommended earlier in the event of development of anal symptoms.
There is no recommended upper age limit for anal cancer screening recommended by the IANS guidelines. US DHHS guidelines for anal cancer screening in PLHIV state that screening should be discontinued when life expectancy is less than 10 years and in individuals with two consecutive negative screening visits who are not currently sexually active18.
The implementation of any recommendations
The implementation of any recommendations for screening of PLHIV to prevent anal cancer in Australia will be limited by a lack of resources, predominantly of high resolution anoscopists. This deficit will be difficult to mitigate in the absence of defined and adequately reimbursed testing and treating tools. An application for Medicare Benefits Schedule listing of anal HPV testing, cytology, HRA and HSIL treatment (MSAC application 1752, 2024) is currently at the final consideration stage. Realistically, public funding will not occur before financial year 2025/2026. Nevertheless, there will be PLHIV who wish to be screened, and this option should be made available to as many as possible, notwithstanding likely out-of-pocket costs.
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