Abstract
This single-center, retrospective cohort study sought to estimate the cumulative incidence in HIV-1-infected patients of biopsy-proven high-grade anal intraepithelial neoplasia (HGAIN) recurrence after infrared coagulation (IRC) treatment. The study was based on data from a prospectively compiled database of 665 HIV-1-infected outpatients who attended a hospital Clinical Proctology/HIV Unit between January 2012 and December 2015. Patient records were checked to see which ones had received IRC treatment but later experienced a recurrence of HGAIN. Cytology samples were also checked for the presence of human papilloma virus (HPV). A total of 81 of the 665 patients (12%, 95%CI: 10–15%), of whom 65 were men and 16 women, were diagnosed with HGAIN and again treated with IRC. Of these 81, 20 (25%) experienced recurrent HGAIN, this incidence being true of both men (16/65, 95%CI: 19–57%) and women (4/16, 95%CI: 10–50%). The median time to recurrence was 6 (2–19) months overall, 6 (2–19) months in men, and 4 (2–6) months in women. HPV infection was detected in all patients except two, with HPV-16 being the most common genotype. This rate of incidence of recurrent HGAIN following IRC treatment is consistent with other reports and highlights the importance of continued post-treatment surveillance, particularly in the first year.
Highlights
Anal cancer (AC) is one of the most common non-AIDS-defining cancers [1], and its incidence has increased in recent decades
Of the 665 HIV-1-infected patients who were attended at our Clinical Proctology HIV Section with at least an anal canal cytology performed, 81 (12%, 95% confidence interval (95%CI): 10–15%) patients were diagnosed with high-grade anal intraepithelial neoplasia (HGAIN) and were treated with Infrared coagulation (IRC)
In the present study of 81 HIV-1-infected patients with a long follow-up, we found the same cumulative incidence of biopsy-proven HGAIN recurrence after IRC treatment in both men and women, namely 25%
Summary
Anal cancer (AC) is one of the most common non-AIDS-defining cancers [1], and its incidence has increased in recent decades. Many studies have pointed in particular to its rise among HIV-1-infected men, especially men who have sex with other men (MSM). Data on AC incidence among HIV-1-infected women are scarce. Infrared coagulation (IRC) has been established as an effective treatment for high-grade squamous intraepithelial lesions (HSIL) [2]. It can be applied at the doctor’s office with local anesthesia and shows a low rate of complications after treatment. The anal canal lesion is identified by means of high-resolution anoscopy (HRA), IRC is applied directly using a short pulse of narrow-beam light, which produces thermal coagulation necrosis [3]. High-grade AIN (HGAIN, which incorporates AIN grades 2 and 3) is often a precursor of AC
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