Anale intraepitheliale Neoplasien

Zusammenfassung

Infektionen mit humanen Papillomviren (HPV) sind häufig bei sexuell aktiven Menschen, in der Mehrzahl der Fälle handelt es sich jedoch um transiente HPV-Infektionen. Bei Immunsuppression, zum Beispiel im Rahmen einer HIV-Infektion, kommt es regelmäßig zu persistierenden Infektionen mit HPV und konsekutiv zu einem deutlich erhöhten Risiko für die Entwicklung von analen intraepithelialen Neoplasien. Besonders davon betroffen sind HIV-positive Männer, die Sex mit Männern (MSM) haben. Hochgradige Dysplasien bei HIV-positiven MSM können innerhalb kurzer Zeit in invasive Analkarzinome übergehen. Wie beim Zervixkarzinom besteht auch beim Analkarzinom eine kausale Assoziation zu HPV-Infektionen, insbesondere mit Hochrisikotypen wie HPV16 und HPV18. Von Experten werden für das Analkarzinom Vorsorgeuntersuchungen mittels Analzytologie in Analogie zum Pap-Screening der Frau vorgeschlagen. Bei pathologischen Befunden in der Analzytologie sollte eine hochauflösenden Anoskopie, und bei klinisch vorhandenen Läsionen sollten therapeutische Maßnahmen erfolgen. Die verschiedenen Behandlungsverfahren bei AIN können in ablative (z.B. Elektrokauterisation, Lasertherapie, Infrarot-Koagulation, chirurgische Exzision) und topische (z.B. Imiquimod, Trichloressigsäure, 5-Fluorouracil) Therapien unterteilt werden, bis dato existieren jedoch nur wenige kontrollierte Studien. Analkarzinome werden in Analrandkarzinome und Analkanalkarzinome unterteilt. Diese Einteilung ist wichtig, da hieraus verschiedene Therapieansätze resultieren. Analrandkarzinome früher Stadien werden wie Plattenepithelkarzinome der Haut primär chirurgisch exzidiert, während Analkanalkarzinome mit kombinierter Radiochemotherapie behandelt werden. Aufgrund der in den vergangenen Jahren kontinuierlich zunehmenden Inzidenzen und Prävalenzen sollten im Bereich HIV/AIDS tätige Ärzte alle HIV-infizierten MSM regelmäßig auf das Vorliegen von analen Dysplasien und Analkarzinomen untersuchen.

Summary

Human papillomavirus (HPV) infections are frequent in sexually active people, but most of these HPV-infections are transient. Immunosuppression, especially in the setting of HIV-infection, is associated with persistent HPV-infections and consecutively leads to a significantly increased risk for anal intraepithelial neoplasia. A particular high-risk group for persistent HPV-infections and anal dysplasia are HIV-positive men who have sex with men (MSM). High-grade anal dysplasia in HIV-positive MSM might progress to invasive cancer within a short period of time. Similar to cervical cancer, anal cancer is causally linked to HPV-infection, particularly to infections with high-risk types such as HPV16 and HPV18. Experts therefore recommend screening examinations for anal cancer including anal cytology similar to Pap-screening in women. In case of abnormal findings in anal cytology, high-resolution anoscopy should be performed, and treatment should be initiated if clinical lesions are present. Treatment modalities for anal dysplasia might be divided into ablative (e.g., electrocautery, laser therapy, infrared-coagulation, and surgical excision) and topical (e.g., imiquimod, trichloroacetic acid, and 5-Fluorouracil) approaches, but so far, only few controlled studies exist. Anal cancer is divided into anal margin carcinoma and anal canal carcinoma. This classification is important because it results in different therapeutic interventions. The treatment of choice for early anal margin carcinoma is surgical excision similar to squamous cell carcinoma of the skin, whereas anal canal carcinoma is treated with combined radiochemotherapy. Facing the continuously increasing incidence and prevalence of anal carcinoma in the last years, physicians working in the field of HIV/AIDS should regularly screen all HIV-positive MSM for the presence of anal dysplasia and anal carcinoma.

Schlüsselwörter

Anale intraepitheliale Neoplasie - Anale Dysplasie - Analkarzinom - HIV-Infektion - Humanes Papillomvirus

Keywords

Anal intraepithelial neoplasia - anal dysplasia - anal carcinoma - HIV-infection - human papillomavirus

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