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Anal Cancer Precursor Lesions in HIV-Infected Persons

Tissue Human Papillomavirus Type Distribution and Impact on Treatment Response

Kobayashi, Takaaki, M.D.1; Sigel, Keith, M.D., Ph.D.2; Kalir, Tamara, M.D., Ph.D.3; MacLeod, Iain J., Ph.D.4; Liu, Yuxin, M.D., Ph.D.3; Gaisa, Michael, M.D., Ph.D.5

Diseases of the Colon & Rectum: May 2019 - Volume 62 - Issue 5 - p 579–585
doi: 10.1097/DCR.0000000000001307
Original Contribution: Colorectal Cancer
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BACKGROUND: Data on tissue distribution of human papillomavirus types in anal high-grade squamous intraepithelial lesions are limited and the impact on treatment outcomes poorly understood.

OBJECTIVE: We aimed to investigate potential predictors of treatment failure after electrocautery ablation, including human papillomavirus type(s) isolated from index lesions.

DESIGN: This was a retrospective cohort study.

SETTINGS: The study was conducted at a tertiary academic referral center in New York City.

PATIENTS: Seventy-nine HIV-infected patients with a diagnosis of anal high-grade squamous intraepithelial lesions between January 2009 and December 2012 were included, and genomic DNA was extracted from biopsy tissue.

MAIN OUTCOME MEASURES: The prevalence of human papillomavirus types in index lesions and surveillance biopsies after electrocautery ablation were analyzed to evaluate treatment response.

RESULTS: Of 79 anal high-grade squamous intraepithelial lesions, 71 (90%) tested positive for ≥1 human papillomavirus type; 8 (10%) had no human papillomavirus detected. The most common type was 16 (39%), followed by 33 (15%). Human papillomavirus type 18 was seen in 3%. Sixty-one patients (77%) underwent electrocautery ablation and had subsequent surveillance biopsies. Surveillance biopsies yielded benign findings or low-grade squamous intraepithelial lesions in 31 (51%) of 61 and recurrent high-grade squamous intraepithelial lesions in 30 (49%) of 61 patients (mean follow-up: 35 mo). Ablation response did not differ significantly based on baseline demographics, smoking history, history of anogenital warts, mean CD4+ T-cell count, antiretroviral-therapy use, and HIV viral load (<50 copies/mL). The recurrence of high-grade lesions was not significantly associated with high-risk human papillomavirus types detected in index lesions.

LIMITATIONS: Human papillomavirus genotyping in surveillance biopsies was not performed.

CONCLUSIONS: Anal high-grade squamous intraepithelial lesions in HIV-infected patients contain a wide range of human papillomavirus types, and individual lesions commonly harbor multiple types concomitantly. Recurrence of anal high-grade squamous intraepithelial lesions after electrocautery ablation occurs frequently and is not affected by high-risk human papillomavirus types. See Video Abstract at

1 Internal Medicine, Mount Sinai Beth Israel, New York, New York

2 Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York

3 Division of Gynecologic Pathology, Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York

4 Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Harvard University, Boston, Massachusetts

5 Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, New York

Funding/Support: This work was supported by funding from the National Cancer Institute (K07CA180782).

Financial Disclosure: None reported.

Poster presentation at the Conference on Retroviruses and Opportunistic Infections, Boston, MA, February 22 to 25, 2016.

Correspondence: Michael Gaisa, M.D., Ph.D., Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1090, New York, NY 10029. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons