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Treatment of High-Grade Anal Intraepithelial Neoplasia With Infrared Coagulation in a Primary Care Population of HIV-Infected Men and Women

Weis, Stephen E. D.O.1,2; Vecino, Isabel M.D.1; Pogoda, Janice M. Ph.D.3; Susa, Joseph S. D.O.4

doi: 10.1097/DCR.0b013e31826d5cb5
Original Contribution: Colorectal/Anal Neoplasia

BACKGROUND: 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.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of infrared coagulation treatment for high-grade anal intraepithelial neoplasia.

DESIGN: 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.

SETTING: This investigation was performed at a Ryan White-funded clinic located in the United States.

PATIENTS: HIV-infected men and women with biopsy-confirmed high-grade anal intraepithelial neoplasia were included.

MAIN OUTCOME MEASURES: The primary outcome measured was the histology collected by high-resolution anoscopy-directed biopsy.

RESULTS: 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.

LIMITATIONS: The study population may not be representative of the general population, the study environment was uncontrolled, and patients were not randomly assigned to treatment.

CONCLUSIONS: 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: weistephen@me.com

© The ASCRS 2012