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Topical Application of Trichloroacetic Acid Is Efficacious for the Treatment of Internal Anal High-Grade Squamous Intraepithelial Lesions in HIV-Positive Men

Cranston, Ross D. MD, FRCP*; Baker, Jonathan R. PA-C; Liu, Yimeng MPH, MS; Wang, Lu MS; Elishaev, Esther MD§; Ho, Ken S. MD*

Sexually Transmitted Diseases: July 2014 - Volume 41 - Issue 7 - p 420–426
doi: 10.1097/OLQ.0000000000000145
Original Study

Objectives: To assess the efficacy of topical 80% trichloroacetic acid (TCA) to treat internal anal high-grade squamous intraepithelial lesions (HSILs) in HIV-positive individuals.

Methods: All patients who attended the University of Pittsburgh Anal Dysplasia Clinic for treatment of biopsy-proven internal anal HSIL with topical TCA between July 1, 2009, and June 30, 2012, and who had 1 or more follow-up visits to assess treatment efficacy were included in the analysis. Recurrence of HSIL was assessed in July 1, 2013.

Results: A total of 98 HSILs from 72 patients were treated, and 77 (78.6%) resolved to normal epithelium or low-grade SIL during follow-up. Forty-eight (49.0%) and 27 (27.6%) of lesions resolved with 1 and 2 TCA treatments, respectively, whereas 1 lesion (1%) each resolved with 3 and 4 TCA treatments. Twenty-one (21.4%) lesions in 20 patients remained without resolution after TCA treatments. These patients were offered an alternative treatment. During follow-up, 8 (15.1%) of 53 patients had a lesion that recurred at the index site (11/53 [20.8%], inclusive of adjacent lesions) and 17 patients had new lesions diagnosed.

Conclusions: Topical TCA is an efficacious treatment of internal anal HSIL in an anal dysplasia clinic setting with high-resolution anoscopy capacity. Advantages of TCA for this recurrent disease process include the following: low cost, no requirement for special equipment beyond that for high-resolution anoscopy, and painless application procedure. A larger prospective comparative study would better define efficacy and patient acceptability between treatment methods.

Using topical 80% trichloroacetic acid to treat internal anal high-grade squamous intraepithelial lesions in HIV-positive men has similar efficacy to more invasive methods.

From the *Department of Medicine, University of Pittsburgh, Pittsburgh, PA; †University of Pittsburgh Medical Center, Pittsburgh, PA; ‡Statistics Consulting Laboratory, Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA; and §Department of Pathology at Magee-Womens Hospital, Pittsburgh, PA

Acknowledgments: The authors thank the study patients for their commitment to the anal dysplasia clinical service at the University of Pittsburgh Anal Dysplasia Clinic. They are grateful to Yuzhou Liu for his work on the data analysis.

Conflict of interest: R.D.C. has received research funding from Merck and Co. For the remaining authors, none were declared.

Presented in abstract: International Society for Sexually Transmitted Disease Research 2011, Montreal, Canada

Funding: Nil.

Correspondence: Ross D. Cranston, MD, FRCP, Department of Medicine, University of Pittsburgh, 3520 Fifth Ave, Pittsburgh, PA 15213. E-mail: rdc27@pitt.edu.

Contributions: R.D.C. wrote the manuscript and directed the analyses. J.R.B. and K.S.H. compiled the clinical database. E.E. reported most of the anal pathology. Statistical analyses were undertaken by Y.L. and L.W. All clinic visits were conducted by R.D.C. and J.R.B. All authors reviewed the manuscript.

Received for publication October 21, 2013, and accepted April 10, 2014.

© Copyright 2014 American Sexually Transmitted Diseases Association