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. 2025 Feb 11;22(1):17.
doi: 10.1186/s12981-025-00709-9.

Challenges in the implementation of a high-resolution anoscopy clinic for people with HIV in an oncologic center in Mexico City

Patricia Volkow  1 , Salim Barquet-Muñoz  2 , Naomi Jay  3 , Maria-José Mendoza  1 , Paulina Moctezuma  2 , Mariel Morales-Aguirre  2 , Delia Pérez-Montiel  4 , Víctor Larraga  1 , Alexandra Martin-Onraet  5
Affiliations

Challenges in the implementation of a high-resolution anoscopy clinic for people with HIV in an oncologic center in Mexico City

Patricia Volkow et al. AIDS Res Ther. .

Abstract

Background: Anal cancer incidence is increased in people with HIV (PWH), up to 60 times higher in men who have sex with men, and almost 15 times higher among women with HIV. Screening and treating high-grade lesions (HSIL) have proven to reduce the incidence of invasive anal cancer. In 2020, we started implementing a high-resolution anoscopy (HRA) clinic at INCan, a tertiary care oncologic center, as part of a screening program for PWH from the HIV clinic.

Objectives: We describe the barriers and difficulties in implementing an HRA Clinic from January 2020 to April 2021, including physician training, the certification process, discrepancies between cytology and histopathologist results, and the lack of experience of gastrointestinal pathologists in HPV-related lesions.

Results: During the first 18 months of the HRA clinic implementation, 124 studies were performed, and 85 biopsies were done. The prevalence of HSIL was 22%. Initially, when a gastrointestinal pathologist reviewed anal canal biopsies, a second opinion was requested from a genitourinary pathologist who examined 72 of the biopsies; there were discrepancies in the diagnosis in 61% of the cases, with more advanced intraepithelial lesions in 43% of cases. Specifically, gastrointestinal pathologists missed 68% of HSILs. The difficulties we faced were not having access to adequate anoscopes. Training and certification are a long way to go. Also, women's reachability was low.

Conclusions: Diagnosis and management of anal HSIL have become a standard of care in the prevention of Anal Carcinoma in PWIH, the population with the highest incidence of this neoplasia. Implementing HRA programs requires correct supplies and equipment, which are not always locally available; investing in physicians' training and an experienced pathologist in HPV-associated lesions interpretation is also imperative. More advocacy is needed for HIV programs to incorporate and invest in anal cancer screening.

Keywords: Anal cancer; Cancer screening; HIV; High-grade squamous intrepithelial lesions; High-resolution anoscopy; Human papilloma virus.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Institutional Ethics and Research Committee approved the protocol (IRB) of the Instituto Nacional de Cancerología (009/006/IBI) (CEI/529/09). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patients’ flow to the HRA clinic. PWH people living with HIV, ID infectious diseases, HRA high resolution anoscopy, FU follow up
Fig. 2
Fig. 2
Supplies to set up an HRA clinic. 1 The office must have a high exploration table. A high-resolution colposcope, an adequate visual system, and a comfortable chair. 2 The supplies must include acetic acid, Lugol, swabs, and containers for each biopsy. 3 There are two types of anoscopes, with and without notch. The preferred anoscopes must not have a notch
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References

    1. Clifford GM, Georges D, Shiels MS, Engels EA, Albuquerque A, Poynten IM, et al. A meta-analysis of anal cancer incidence by risk group: toward a unified anal cancer risk scale. Int J Cancer. 2021;148(1):38–47. - PMC - PubMed
    1. Wei F, Gaisa MM, D’Souza G, Xia N, Giuliano AR, Hawes SE, et al. Epidemiology of anal human papillomavirus infection and high-grade squamous intraepithelial lesions in 29 900 men according to HIV status, sexuality, and age: a collaborative pooled analysis of 64 studies. Lancet HIV. 2021;8(9):e531–43. - PMC - PubMed
    1. Wang CCJ, Palefsky JM. HPV-associated anal cancer in the HIV/AIDS Patient. In: Meyers C, editor. HIV/AIDS-associated viral oncogenesis. Cham: Springer International Publishing; 2019. p. 183–209 (Cancer Treatment and Research; vol. 177). 10.1007/978-3-030-03502-0_7 - PubMed
    1. Palefsky JM, Lee JY, Jay N, Goldstone SE, Darragh TM, Dunlevy HA, et al. Treatment of anal high-grade squamous intraepithelial lesions to prevent anal cancer. N Engl J Med. 2022;386(24):2273–82. - PMC - PubMed
    1. European AIDS Clinical Society. EACS guidelines 12.0 [Internet]. 2023 Oct. Available from: https://www.eacsociety.org/guidelines/interim-guidance/

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