Initial experience with topical fluorouracil (5-FU) for treatment of anal intraepithelial neoplasia (AIN) in HIV-positive patients

Abstract

Background Exposure to certain strains of human papilloma virus (HPV) promotes dysplasia in cells of the anal canal epithelium, leading to AIN, which is in turn a precursor to squamous cell carcinoma of the anus (SCCA). Patients with HIV infection who have anoreceptive intercourse are at heightened risk for acquiring HPV, AIN, and SCCA. The use of topical 5-FU to prevent the progression of lower genital tract neoplasia to invasive cervical carcinoma has been studied in both HIV+ and HIV- women. Although intravenous 5-FU is also commonly used for treatment of invasive SCCA, there has been little experience with the use of topical 5-FU as therapy for AIN. Materials and methods We retrospectively reviewed medical records from our anal dysplasia clinic. Our study population comprised 11 HIV+ men with biopsy-proven AIN who were treated with topical 5-FU. All patients were initially instructed to apply a pea-sized amount of topical 5-FU to the anus each night, to wash their hands afterwards, and to wipe away excess 5-FU in the morning. Patients reduced the frequency of application if they experienced undue local irritation. Results