To the Editor We were delighted to read the cohort study by Arnold et al1 that found an association between anogenital warts (AGW) and increased anal cancer (AC) rates in people living with HIV (PLHIV) (4.4% vs 0.3%; P < .001). Raising awareness among clinicians is important given the rising rates of AC. The authors concluded that PLHIV with AGW need counseling for increased AC risk but stopped short of recommending screening, citing a lack of evidence and few clinicians trained in high-resolution anoscopy (essentially colposcopy of the anal canal). Anal cancer is similar to cervical cancer in human papillomavirus (HPV) cause, pathogenesis at a squamocolumnar transition zone, and avenues for diagnosis and treatment of high-grade squamous intraepithelial lesions (HSIL), the cancer precursor.