Long-term effectiveness of infrared coagulation for the treatment of anal intraepithelial neoplasia grades 2 and 3 in HIV-infected men and women

Sirera, Guillema,b,*; Videla, Sebastiána,*; Piñol, Martac; Coll, Josepa,d; García-Cuyás, Francescc; Vela, Sandrac; Cañadas, MariPaza,e; Darwich, Lailaa,f; Pérez, Núriaa; Gel, Silviaa; Cobarsi, Patriciaa; Clotet, Bonaventuraa,b,d; on behalf of the HIV-HPV Study Group

doi: 10.1097/QAD.0b013e32835e06c1
Clinical Science

Aims: To assess the effectiveness and safety of infrared coagulation (IRC) for the ablation of anal intraepithelial neoplasia (AIN) and to provide data on the prevalence of AIN in HIV-infected patients.

Patients and methods: We performed a single-center, retrospective cohort study based on data collected from a prospectively compiled database of outpatients attended in the Clinical-Proctology-HIV-Unit (first visit). The effectiveness (normal anal cytology after 12 months of IRC) and safety of IRC were estimated.

Results: Between January 2005 and December 2011, a total of 69 (5%) patients with biopsy-proven AIN-2 or AIN-3 from among 1518 patients (1310 men; 208 women) were treated with IRC. The prevalence of cytological abnormalities was 49.5% [751/1518; (atypical squamous cells of unknown significance, 14%; low-grade squamous intraepithelial lesions, 27.5%; high-grade squamous intraepithelial lesions, 8%)]. High-resolution anoscopy revealed intra-anal condylomata in 31% of patients (236/751), nonvisualized lesions in 30% (227/751), and visualized lesions (from which biopsy specimens were taken) in 38% (288/751). The histological diagnosis was: AIN-1, 52% (151/288); AIN-2, 15% (44/288); AIN-3, 9% (25/288); normal, 19% (56/288); and nonevaluable, 4% (12/288). IRC was applied in-office in 66 patients (three refused to undergo treatment). At 12 months, all patients (n = 56) had a normal anal cytology result. Seven (13%) patients had biopsy-proven recurrence [mean (range) time-to-recurrence, 30 (18–43) months]. High-risk-human papilloma virus (HPV) infection was detected in all anal lesions (HPV-16 was the most common genotype). Agreement between cytological and histological results was poor.

Conclusion: A high prevalence of AIN was found in both HIV-infected men and HIV-infected women. Although randomized clinical trials are lacking, IRC ablation of AIN-2 and AIN-3 lesions without concomitant condylomata could help prevent anal squamous cell carcinoma.

Author Information

aLluita Contra La SIDA Foundation

bHIV Clinical Unit, Department of Medicine

cDepartment of Surgery

dRetrovirology Laboratory IrsiCaixa Foundation; University Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Catalonia

eLabco.GeneralLab, Barcelona

fDepartment of Sanitat i Anatomia Animal, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.

*Guillem Sirera and Sebastián Videla contributed equally to the writing of this article.

Correspondence to Sebastián Videla, MD, PhD; Fundació Lluita Contra la SIDA; Hospital Universitari Germans Trias i Pujol; 08916 Badalona (Barcelona), Spain. Tel: +34 93 465 63 74; fax: +34 93 465 39 68; e-mail: svidela@flsida.org/svidela@esteve.es

Received 9 August, 2012

Revised 9 December, 2012

Accepted 17 December, 2012

© 2013 Lippincott Williams & Wilkins, Inc.