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Brief Report

Effectiveness of Trichloroacetic Acid vs. Electrocautery Ablation for the Treatment of Anal High-Grade Squamous Intraepithelial Lesion in HIV-Infected Patients

Burgos, Joaquin, MD, PhD*; Martin-Castillo, Mario, MD; Landolfi, Stefania, MD; Dinares, Maria C., MD; Villar, Judith, MD, PhD‡,§; Navarro, Jordi, MD*; Ribera, Esteve, MD, PhD*; Falcó, Vicenç, MD, PhD*; Curran, Adria, MD, PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15, 2018 - Volume 79 - Issue 5 - p 612–616
doi: 10.1097/QAI.0000000000001847
Clinical Science

Background: Trichloroacetic acid (TCA) and electrocautery ablation (ECA) are 2 of the main treatment options for anal high-grade squamous intraepithelial lesion (HSIL). Our aim was to compare the efficacy and tolerance of TCA vs. ECA for HSIL.

Methods: Retrospective uncontrolled study of HIV-infected men who have sex with men who had an anal HSIL treated with TCA or ECA. On-treatment effectiveness was evaluated at 6–8 weeks after treatment. A complete response was defined as resolution of HSIL, a partial response as regression to low-grade lesion, and recurrence as biopsy-proven HSIL during follow-up. A propensity-score analysis was used to adjust efficacy to potential confounding.

Results: From May 2009 to March 2018, 182 and 56 cases of anal HSIL were treated with ECA and TCA, respectively. Comparing ECA with TCA, a complete response was observed in 33.5% (95% confidence interval: 25.8 to 41.6) vs. 60.7% (50.0 to 74.8) and a partial response in 28.0% (20.3 to 36.0) vs. 23.2% (12.5 to 37.3), respectively (P < 0.001). These differences were maintained in the propensity-score analyses. Side effects were common in both treatment, but tolerance was reported as good in 80.6% (74.2 to 89.2) and 82.6% (73.9 to 93.9) of cases treated with ECA and TCA, respectively, and no serious events were described. Recurrence cumulative incidence for the first 12 months was 14.6% (9.1 to 23.1) for ECA episodes and 27.6% (11.5 to 57.7) for TCA (P = 0.183).

Conclusions: Our study showed a higher efficacy of TCA than ECA with similar rates of side effects. In our opinion, considering the benefits of TCA, it should be considered as a first-line therapy for most anal HSIL management.

*Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain;

Infectious Diseases Department, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain;

Anatomical Pathology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; and

§Internal Medicine Department, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Spain.

Correspondence to: Joaquin Burgos, MD, PhD, Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain (e-mail: jburgos@vhebron.net).

Supported by the SPANISH AIDS Research Network RD16/0025/0007—ISCIII—FEDER.

The authors have no funding or conflicts of interest to disclose.

Received May 14, 2018

Accepted July 16, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.