Evaluating the effectiveness of high-resolution anoscopy screening for anal cancer in HPV- patients and people living with HIV

Anal cancer primarily affects high-risk populations, including individuals co-infected with HIV and HPV. This retrospective, monocentric study aimed to evaluate the effectiveness of high-resolution anoscopy (HRA) in detecting precancerous lesions, such as HSIL (high-grade squamous intraepithelial lesions) and LSIL (low-grade squamous intraepithelial lesions), in patients with HIV and HPV. Between June 2022 and May 2024, 258 patients aged over 18 with HIV and HPV underwent cytology and HRA screening. Patients with HSIL were treated and followed every six months, while those with LSIL were monitored annually. Results showed that out of the 180 patients who had cytology, 41 had suspicious lesions on HRA, with only 29% confirmed by histology. Among patients with LSIL, 5 were confirmed by histology, and for HSIL, 7 were confirmed. Statistical analysis indicated a risk ratio (RR) of 1.0176 (p = 0.57) for the association between high-risk HPV and precancerous lesions. The study concludes that routine screening with pap tests and HRA is crucial for early detection in this high-risk population, and future efforts should focus on optimizing screening protocols, incorporating molecular biomarkers, and exploring machine learning predictive models to improve diagnostic accuracy.