Anal High-Grade Squamous Intraepithelial Lesions in People Living with HIV: A Systematic Review of Treatment Outcomes
In brief
Over half of HIV patients experience anal HSIL recurrence after treatment
A review of 45 studies involving 6,093 people living with HIV found that while ablative, topical and surgical methods can clear anal high-grade lesions short-term, more than 50% of patients later have a recurrence, reflecting the chronic HPV-driven nature of disease. Serious side effects are rare, but frequent mild morbidity and limited durable control highlight the need for better therapies and ongoing surveillance.
- Journal
- Cancers (Q1)
- Published
- 11 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Hendrik Dapper, Felix Aigner, Christoph Stephan, Claudia Rudroff, Daniel Martin, Franz Rödel, et al.
- PMID
- 42649891
- DOI
- 10.3390/cancers18162577
Why clinicians should know about it
- Picked for Biochemistry (medical) (top studies of the week, 30 August 2026): Anal HSIL treatment outcomes in people with HIV
- Picked for Pathology and Forensic Medicine (top studies of the week, 30 August 2026): Treatment outcomes, no pathology classification focus
Abstract
Background/Objectives: People living with HIV (PLWH) are at substantially increased risk of anal high-grade squamous intraepithelial lesions (HSIL), a recognized precursor of anal cancer. Although the ANCHOR trial demonstrated that treatment reduces progression to invasive disease, important uncertainties remain regarding durability of response, recurrence patterns, and treatment-related toxicity across available therapeutic strategies. Methods: We conducted a systematic review of studies evaluating treatment outcomes for anal HSIL published between 2000 and 2026. PubMed, Embase, and the Cochrane Library were searched according to PRISMA guidelines, with a particular focus on studies involving PLWH. Results: A total of 45 studies comprising 6093 patients, including five randomized controlled trials, met the inclusion criteria. Definitions of treatment response, recurrence, and adverse events varied considerably across studies, together with differences in assessment methods and follow-up, limiting direct comparisons between treatment modalities. Ablative, topical, and surgical approaches achieved variable short-term clearance; however, no modality demonstrated consistent durable disease control. Recurrence rates were high, frequently exceeding 50% in PLWH, consistent with the chronic and relapsing nature of HPV-driven disease in this population. Serious adverse events were uncommon, although treatment-related morbidity was frequent and varied across modalities. Conclusions: Randomized evidence supports treatment of biopsy-confirmed anal HSIL in PLWH for prevention of squamous cell carcinoma of the anus. However, comparative evidence remains limited by few randomized trials, heterogeneous study designs, and inconsistent outcome reporting. High recurrence rates and limited durability of response support the need for improved therapeutic strategies, biomarker-driven risk stratification, and longitudinal management approaches.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.