Regional and national guideline recommendations for digital ano-rectal examination as a means for anal cancer screening in HIV positive men who have sex with men: a systematic review

BMC Cancer

Christopher K Fairley³  Andrew E Grulich¹  Marcus Chen³  Jason J Ong² 

[1]Kirby Institute, University of New South Wales, Sydney NSW 2052, Australia

[2]Melbourne School of Population and Global Health, University of Melbourne, 580 Swanston Street, Carlton, Victoria 3053, Australia

[3]Central Clinical School, Monash University, Clayton Victoria 3168, Australia

关键词: Men who have sex with men;    HIV positive;    Digital ano-rectal examination;    Guidelines;    Systematic review;    Anal cancer screening;   

Others  :  1125256
DOI  :  10.1186/1471-2407-14-557

 received in 2013-09-09, accepted in 2014-07-04,  发布年份 2014

【 摘 要 】

Background

Although anal cancer is common in HIV positive men who have sex with men, few centres offer systematic screening. Regular digital ano-rectal examination (DARE) is a type of screening that has been recommended by some experts. How widely this forms part of HIV management guidelines is unclear.

Methods

The protocol was registered prospectively (CRD42013005188; http://www.crd.york.ac.uk/PROSPERO/ webcite). We systematically reviewed 121 regional and national HIV guidelines and searched for guidelines from http://hivinsite.ucsf.edu/global?page=cr-00-04#SauguidelineX webcite, PubMed and Web of Science databases up to 5^th August 2013 for recommendations of DARE as a means of anal cancer screening in HIV positive MSM. Guidelines were examined in detail if they were clinical guidelines, including both prevention and treatment protocols and were in English. Guidelines were excluded if they were restricted to limited areas (e.g. antiretroviral therapy only, children or pregnant women, strategies for prevention/testing). Information was extracted regarding recommendation of DARE as a screening method, the frequency of DARE recommended, target population for screening and the strength of evidence supporting this.

Results

30 regional and national guidelines were included and examined in detail. Only 2 recommended DARE. The ‘European AIDS Clinical Society Guidelines’ recommends DARE every 1–3 years for HIV positive MSM whilst the ‘US Guideline for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents’ recommends an annual DARE for the HIV + population in general. None of these guidelines specify the age of commencing screening. In each case, the highest level of evidence supporting these two recommendations was expert opinion.

Conclusions

Few HIV guidelines discuss or recommend DARE as a means of anal cancer screening. Studies of the efficacy, acceptability and cost-effectiveness of DARE are needed to assess its role in anal cancer screening.

【 授权许可】

   
2014 Ong et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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