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Condyloma Acuminatum, Anal Intraepithelial Neoplasia, and Anal Cancer in the Setting of HIV: Do We Really Understand the Risk?

Fazendin, Edward A. M.D.1; Crean, Alexander J. M.D.1; Fazendin, Jessica M. M.D.1; Kucejko, Robert J. M.D.1; Gill, Harkenwar S. M.D.1; Poggio, Juan L. M.D.2; Stein, David E. M.D.3

doi: 10.1097/DCR.0000000000000890
Original Contributions: Anorectal Disease
Denotes Associated Video Abstract
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BACKGROUND: The gold standard for surveillance of patients with anal lesions is unclear.

OBJECTIVE: The aim of this study was to stratify patients for risk of progression of disease and to determine appropriate intervals for surveillance of patients with anal disease.

DESIGN: This was a retrospective chart review for patients treated for anal lesions between 2007 and 2014. Only patients with ≥1 year of follow-up from index evaluation, pathology, documented physical examination, and anoscopy findings were included for analysis.

SETTINGS: The study was conducted at an urban university hospital.

PATIENTS: HIV-positive patients with anal lesions treated with excision and fulguration were included.

MAIN OUTCOME MEASURES: Recurrence of anal lesions, progression of disease, and progression to cancer were measured.

RESULTS: Ninety-one patients met inclusion criteria. The mean age was 41.6 years, and mean follow-up was 38.6 months (range, 11.0–106.0 mo). On initial pathology, 8 patients (8.8%) had a diagnosis of condyloma acuminatum without dysplasia, 20 patients (22%) had anal intraepithelial neoplasia I, 32 (35.2%) had anal intraepithelial neoplasia II, and 31 (34.1%) had anal intraepithelial neoplasia III. Sixty-nine patients (75.8%) had repeat procedures. Seven (87.5%) of 8 patients with condyloma and 6 (30%) of 20 patients with anal intraepithelial neoplasia I progressed to high-grade lesions. Five (15.6%) of 32 patients progressed from anal intraepithelial neoplasia II to III, and 2 patients with anal intraepithelial neoplasia III (6.5%) developed squamous cell carcinoma (2.3% for the entire cohort).

LIMITATIONS: This was a single institution study. High-resolution anoscopy was not used.

CONCLUSIONS: All of the HIV-positive patients with condyloma or anal intraepithelial neoplasia, regardless of the presence of dysplasia, should be surveyed at equivalent 3-month time intervals, because their risk of progression of disease is high. Video Abstract at http://links.lww.com/DCR/A389.

1 Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania

2 Division of Colorectal Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania

3 Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, Pennsylvania

Funding/Support: None reported.

Financial Disclosure: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Los Angeles, CA, April 30 to May 4, 2016.

Correspondence: Edward A. Fazendin, M.D., Department of Surgery, Drexel University College of Medicine, 245 N 15th St, MS 413, Philadelphia, PA 19102. E-mail: afazendin@gmail.com

© 2017 The American Society of Colon and Rectal Surgeons