Australian guidelines for anal cancer screening using anal human papillomavirus testing with cytology triage in people living with HIV.

OBJECTIVES

To develop Australian anal cancer screening guidelines for people living with HIV.

METHODS

In 2023, ASHM Health assembled a committee to create guidelines, based on existing international guidelines and utilizing data from the Study of the Prevention of Anal Cancer (SPANC). SPANC provided Australian-specific data on different screening methodologies for the detection of anal high-grade squamous intraepithelial lesions.

RESULTS

The guidelines were released in March 2025. They recommend primary high-risk human papillomavirus (HRHPV) testing with cytology triage for high-resolution anoscopy. Gay, bisexual and other men who have sex with men (GBM) and trans-women living with HIV should be offered screening from 35 years of age. Cis-women, trans-men and other cis-men (not GBM) living with HIV should be offered screening from 45 years of age. All anal cancer screening should include annual digital ano-rectal examination, examination of the peri-anal region and a thorough medical history. Screening should be repeated every 3 years for those who screen negative. Screening should be discontinued, with shared decision-making, at age 75 years and/or in individuals with two consecutive negative screening visits who are not currently sexually active.

CONCLUSIONS

These are the first guidelines to recommend primary HRHPV testing with cytology triage as the screening modality. They will assist clinicians in identifying and screening people living with HIV at higher risk of anal cancer and will enable screening and referral of people living with HIV at highest risk for high-resolution anoscopy, while screening and treatment services capacity are expanded in Australia.