Abstract
BackgroundThere is limited information on the effectiveness of available treatments for anal condyloma acuminata in HIV-1-infected men.AimTo provide data on the effectiveness of electrosurgical excision, infrared coagulation and pharmacological (imiquimod) treatments for anal condyloma acuminata (peri-anal and/or intra-anal) in HIV-1-infected men based on authors’ practice.MethodsSingle-center, retrospective descriptive analysis of HIV-1-infected men, 18 years or older treated for anal condyloma acuminata. Standard treatments were offered: electrosurgery excision, infrared coagulation and topical imiquimod. Effectiveness was evaluated by the recurrence rate at 1 year after treatment. Recurrence was defined as any anal condyloma acuminata diagnosed after 3 months of condyloma-free survival post-treatment. Anal cytology and human-papillomavirus-infection (HPV) was assessed.ResultsBetween January 2005 and May 2009, 101 men were treated for anal condyloma acuminata: 65 (64%) with electrosurgery, 27 (27%) with infrared coagulation and 9 (9%) with imiquimod. At 1 year after treatment, the cumulative recurrence rate was 8% (4/65, 95%CI: 2–15%) with electrosurgery excision, 11% (3/27, 95%CI: 4–28%) with infrared coagulation and 11% (1/9, 95%CI: 2–44%) with imiquimod treatment. No predictive factors were associated with recurrence.Anal HPV-6 or HPV-11 was detectable in 98 (97%) patients and all had high-risk HPV genotypes, and 89 (88%) patients had abnormal anal canal cytology. Limitations: this was a retrospective descriptive analysis; limited to a single center; it cannot know if the recurrence is related to new infection.ConclusionRecurrence of anal condyloma after any treatment was common. Abnormal anal cytology and high-risk HPV-infection were highly prevalent in this population, therefore at high-risk of anal cancer, and warrants careful follow-up.
Highlights
Anal condyloma acuminata (CA) are frequently associated with human papillomavirus (HPV) types 6 and 11 [1,2]
The corresponding author had full access to all study data and had final responsibility for the decision to submit the Single-center, retrospective descriptive analysis of HIV-1-infected men, 18 years or older treated for anal condyloma acuminata
Between January 2005 and May 2009, 101 men were treated for anal condyloma acuminata: 65 (64%) with electrosurgery, 27 (27%) with infrared coagulation and 9 (9%) with imiquimod
Summary
Anal condyloma acuminata (CA) are frequently associated with human papillomavirus (HPV) types 6 and 11 [1,2]. A high regression rate in the first year after diagnosis of genital warts can be common among HIV-1-infected women (on 60%) and in general population (80%) [10] Despite this regression rate, the main challenge in clinical practice for any treatment is the high percentage of recurrence, after a long period of follow-up, independent of the type of treatment used [7,11,12,13]. Albeit these treatments can result in resolution of the wart, removing the lesion is not synonymous with eradicating the HPV infection, and this may explain the high recurrence rate, regardless of the treatment modality employed. There is limited information on the effectiveness of available treatments for anal condyloma acuminata in HIV-1-infected men
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