The importance of HIV status and gender when designing prevention strategies for anal cancer.

Our objective is to review and summarize relevant aspects of the literature regarding human papillomavirus (HPV), the most common sexually transmitted infection in the United States, and to compare how the trajectory of HPV may differ in persons who are and who are not co-infected with HIV. This comparison is particularly important because the literature on HPV has been largely based on individuals who are not co-infected with HIV. Also, HPV findings may differ in HIV-uninfected individuals versus HIV-infected individuals. In addition, many reviews ignore gender differences, although in HIV-uninfected individuals, anal cancers are up to 4 times more prevalent in women than men. Clinical decision making may be problematic if such critical factors as HIV status and gender are neglected. Therefore, we will review existing information on how HIV status and gender may affect the manifestation of HPV, particularly focusing on epidemiology, screening, and treatment issues.