High-grade anal intraepithelial neoplasia, the putative anal carcinoma precursor, is more common in HIV-infected persons. The ideal treatment for these lesions has not been established.
The aim of this study was to evaluate the effectiveness of infrared coagulation treatment for high-grade anal intraepithelial neoplasia.
This is a prospective cohort study. Patients with high-grade anal intraepithelial neoplasia either received infrared coagulation treatment or voluntarily did not receive treatment and were reevaluated at a subsequent time point.
This investigation was performed at a Ryan White-funded clinic located in the United States.
HIV-infected men and women with biopsy-confirmed high-grade anal intraepithelial neoplasia were included.
The primary outcome measured was the histology collected by high-resolution anoscopy-directed biopsy.
The study included 124 patients. Of 42 patients who either delayed treatment or were not treated, 37 (88%; 95% CI = 74%–96%) still had high-grade anal intraepithelial neoplasia on reevaluation and 2 (5%; 95%CI = 1%–16%) had squamous-cell carcinoma. Of 98 patients who received infrared coagulation treatment, 73 (74%; 95% CI = 65%–83%) patients had no evidence of high-grade anal intraepithelial neoplasia on their first posttreatment evaluation, and none had progressed to squamous-cell carcinoma (p < 0.0001 in comparison with untreated). Upon completing all initial and, if necessary, follow-up treatment, 85 (87%; 95% CI = 78%–93%) patients treated by infrared coagulation had no evidence of high-grade anal intraepithelial neoplasia and none had progressed to squamous-cell carcinoma.
The study population may not be representative of the general population, the study environment was uncontrolled, and patients were not randomly assigned to treatment.
Infrared coagulation is an effective treatment for high-grade anal intraepithelial neoplasia.
1 Dermatology Division of the Department of Internal Medicine, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas
2 Preventive Medicine Clinic, Tarrant County Public Health, Fort Worth, Texas
3 Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angelos, California
4 Department of Dermatology, University Texas Southwestern Medical School, Dallas, Texas
Support/Funding: Clinic activities were funded by the North Central Texas HIV Planning Council.
Financial Disclosures: None reported.
Correspondence: Stephen E. Weis, D.O., Patient Care Center, Department of Medicine, 855 Montgomery, Fort Worth, TX 76107. E-mail: firstname.lastname@example.org