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Treatment of High-Grade Anal Intraepithelial Neoplasia With Infrared Coagulation in a Primary Care Population of HIV-Infected Men and Women.
MedLine Citation:
PMID:  23135581     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: : High-grade anal intraepithelial neoplasia, the putative anal carcinoma precursor, is more common in HIV-infected persons. The ideal treatment for these lesions has not been established.
OBJECTIVE: : The aim of this study was to evaluate the effectiveness of infrared coagulation treatment for high-grade anal intraepithelial neoplasia.
DESIGN: : This is a prospective cohort study. Patients with high-grade anal intraepithelial neoplasia either received infrared coagulation treatment or voluntarily did not receive treatment and were reevaluated at a subsequent time point.
SETTING: : This investigation was performed at a Ryan White-funded clinic located in the United States.
PATIENTS: : HIV-infected men and women with biopsy-confirmed high-grade anal intraepithelial neoplasia were included.
MAIN OUTCOME MEASURES: : The primary outcome measured was the histology collected by high-resolution anoscopy-directed biopsy.
RESULTS: : The study included 124 patients. Of 42 patients who either delayed treatment or were not treated, 37 (88%; 95% CI = 74%-96%) still had high-grade anal intraepithelial neoplasia on reevaluation and 2 (5%; 95%CI = 1%-16%) had squamous-cell carcinoma. Of 98 patients who received infrared coagulation treatment, 73 (74%; 95% CI = 65%-83%) patients had no evidence of high-grade anal intraepithelial neoplasia on their first posttreatment evaluation, and none had progressed to squamous-cell carcinoma (p < 0.0001 in comparison with untreated). Upon completing all initial and, if necessary, follow-up treatment, 85 (87%; 95% CI = 78%-93%) patients treated by infrared coagulation had no evidence of high-grade anal intraepithelial neoplasia and none had progressed to squamous-cell carcinoma.
LIMITATIONS: : The study population may not be representative of the general population, the study environment was uncontrolled, and patients were not randomly assigned to treatment.
CONCLUSIONS: : Infrared coagulation is an effective treatment for high-grade anal intraepithelial neoplasia.
Authors:
Stephen E Weis; Isabel Vecino; Janice M Pogoda; Joseph S Susa
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-08     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1236-43     Citation Subset:  IM    
Affiliation:
1 Dermatology Division of the Department of Internal Medicine, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas 2 Preventive Medicine Clinic, Tarrant County Public Health, Fort Worth, Texas 3 Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angelos, California 4 Department of Dermatology, University Texas Southwestern Medical School, Dallas, Texas.
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