Anal squamous intraepithelial lesions in HIV+ MSM

In this thesis we report on several aspects of high-grade anal squamous intraepithelial lesions (HSIL) in HIV+ men who have sex with men (MSM). It is estimated that 10% of HIV+ MSM with anal HSIL will develop anal squamous cell carcinoma (ASCC) over 30 years time. Screening programs similar to cervical cancer screening focus on identification and treatment of anal HSIL. However, if ASCC can be prevented is still subject of debate. We report on risk factors for anal HSIL, causative HPV-types of intra-anal condylomatous lesions, the learning curve for high-resolution anoscopists identifying HSIL, the impact of anal HSIL treatments (electrocoagulation, imiquimod creme and efudix creme) on quality of life and sex life of HIV+ MSM and on cryotherapy as a potential new treatment for anal HSIL.