Wieland Ulrike, Oellig Frank, Kreuter Alexander
Institut für Virologie, Nationales Referenzzentrum für Papillom- und Polyomaviren, Universität zu Köln, Köln, Deutschland.
Institut für Pathologie, Mühlheim an der Ruhr, Deutschland.
Hautarzt. 2020 Apr;71(4):284-292. doi: 10.1007/s00105-020-04548-9.
Anal intraepithelial neoplasia (AIN) and 89-100% of anal cancers are caused by persistent infections with high-risk (HR) human papillomaviruses (HPV). In HIV-positive patients, anal HPV infection and AIN are very common and these patients have a greatly increased risk of developing anal cancer. However, a continuous increase in the incidence of anal cancer has also been observed in the general population in recent decades. AIN can clinically present in diverse manners. In HIV-positive patients AIN can be hidden in condylomas. Furthermore, 3-14% of high-grade AIN progress to anal cancer within 5 years. Therefore, screening examinations should be offered to patients with an increased risk for anal cancer. The treatment options for AIN are similar to those for condylomas. HIV-positive patients with controlled immune status and HIV-negative patients with anal cancer respond comparably well to combined radiochemotherapy. A German-language AWMF S3 guideline for anal cancer will be available in 2020. In HIV-positive patients over 26 years of age, HPV vaccination showed no effect in a controlled phase‑3 study. To prevent AIN and anal cancer in the future, HPV vaccination rates need to be increased in HPV-naïve girls and boys.
肛管上皮内瘤变（AIN）以及89%至100%的肛管癌是由高危（HR）人乳头瘤病毒（HPV）持续感染引起的。在HIV阳性患者中，肛管HPV感染和AIN非常常见，这些患者患肛管癌的风险大幅增加。然而，近几十年来，普通人群中肛管癌的发病率也在持续上升。AIN在临床上可有多种表现形式。在HIV阳性患者中，AIN可能隐匿于尖锐湿疣中。此外，3%至14%的高级别AIN在5年内会进展为肛管癌。因此，对于肛管癌风险增加的患者应进行筛查。AIN的治疗选择与尖锐湿疣相似。免疫状态得到控制的HIV阳性患者和患有肛管癌的HIV阴性患者对联合放化疗的反应相当。一份德语的AWMF S3肛管癌指南将于2020年发布。在一项对照的3期研究中，26岁以上的HIV阳性患者接种HPV疫苗未显示出效果。为了未来预防AIN和肛管癌，未感染HPV的女孩和男孩的HPV疫苗接种率需要提高。
