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Using a mathematical model, we simulated the life course ofhypothetical HIV-positive men who have sex with men MSM who were 27 years or older Danielle reaches anal were diagnosed with high-grade squamous intraepithelial lesions. In our model, we compared four different management strategies: We followed these hypothetical patients over their lifetime in our computer model to estimate harms and benefits of the management strategies. We tracked the number of individuals who developed anal cancer and then estimated their risk of death from anal cancer.

We then estimated above outcomes by patient age.

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For each strategy, we estimated age-specific lifetime outcomes considering cost, quality of life ansl life expectancy. We found that HIV-infected gay and bisexual men who are 38 years or older should be treated using surgical treatment of ablation either infrared Danielle reaches anal or electrocauteryand that HPV vaccination should be administered at the time of surgery. This strategy is cost-effective and has the potential to decrease the lifetime risk of anal cancer by up to 80 percent in those men. The model also found that because younger men are more likely to be cured of their precancer without intervention, patients younger than 29 should not be treated and those between 29 and 38 years old should be actively monitored watch-and-wait approach in order to prevent treatment-related inconvenience and morbidity that might affect their quality of life.

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