AMC-052 HPV On-Study Form NCT00513526 Human Papillomavirus Vaccine Therapy in Treating Men With HIV-1 Infection Source Form: NCI FormBuilder:


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June 3, 2015

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AMC-052 HPV On-Study Form NCT00513526

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  1. StudyEvent: AMC-052 HPV On-Study Form
    1. No Instruction available.
HIV status
CDC HIV Risk Group
Prior Systemic Chemotherapy
Has the patient received radiation therapy?
History of anal, perianal, or genital condyloma (If yes check all that apply)
History of penile or genital condyloma
History of perianal condyloma
History of intraanal condlyoma
Anal cytology/biopsy
Anal cytology performed (prior to screening to AMC052)
Anal cytology result (if yes)
Anal or perianal biopsy performed (prior to screening to AMC052)
Most severe anal biopsy result
Footer module
Smoked at least 100 cigarettes (5 packs) during lifetime
Document type

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