Response to CRT should be assessed at 6–8 weeks after completion of CRT. Clinical evaluation, MRI selleck screening library imaging of the pelvis and EUA is usually performed. Earlier evaluation may underestimate response rates and indeed in the ACT II trial (which excluded people living with HIV), 29% of patients who had not achieved a complete response (CR) at 11 weeks after CRT subsequently achieved CR at 26 weeks [73]. Hence residual disease should be confirmed histologically. Follow-up protocols for the general population suggest clinical evaluation and review every

3–6 months for 2 years and every 6–12 months up to 5 years [45]. We suggest a similar approach in people living with HIV (level of evidence 2D) and advocate surveillance for AIN by high-resolution

anoscopy (HRA) (level of evidence 2D). We recommend the examination under anaesthetic (EUA) of the anal canal and rectum with biopsy in all suspected cases (level of evidence 1D). We recommend that staging for anal cancer following EUA and biopsy includes computerized Nintedanib datasheet tomography (CT) of the chest, abdomen and pelvis and MRI of the pelvis in order to assess regional lymph nodes and tumour extension [2] (level of evidence 1B). We recommend that the management of HIV patients with anal cancer is in specialized centres where there is MDT experience in order to ensure optimal outcomes [2] (level of evidence 1C). We suggest that centres caring for these patients should be able to provide high-resolution anoscopy (HRA) services (level of evidence 2D). We recommend CRT with 5-fluorouracil and mitomycin C (level of evidence 1A). We recommend that all people living with HIV who are to be treated with CRT should start HAART (level of evidence 1C) and opportunistic

3-mercaptopyruvate sulfurtransferase infection prophylaxis (level of evidence 1D). We suggest that salvage surgery may be appropriate for people living with HIV who experience loco-regional disease persistence or relapse following CRT (level of evidence 2D). We suggest that best supportive care may be more appropriate for patients with metastatic disease or local relapse following salvage surgery (level of evidence 2D). We suggest a similar approach in people living with HIV (level of evidence 2D) and advocate surveillance for AIN by HRA (level of evidence 2D). 1 Fakoya A, Lamba H, Mackie N et al. British HIV Association, BASHH and FSRH guidelines for the management of the sexual and reproductive health of people living with HIV infection 2008. HIV Med 2008; 9: 681–720. 2 National Institute for Clinical Care and Excellence. Improving Outcomes in Colorectal Cancers. Cancer service guidance CSGCC. June 2004. Available at: http://www.nice.org.uk/CSGCC (accessed December 2013). 3 Melbye M, Rabkin C, Frisch M, Biggar RJ. Changing patterns of anal cancer incidence in the United States, 1940–1989.