Article ; Online: Treatment of high-grade anal intraepithelial neoplasia with infrared coagulation in a primary care population of HIV-infected men and women.
Diseases of the colon and rectum
2012 Volume 55, Issue 12, Page(s) 1236–1243
Abstract: 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 ... ...
| Abstract | 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. |
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| MeSH term(s) | Adult ; Analysis of Variance ; Anus Diseases/surgery ; Biopsy ; Female ; HIV Infections/complications ; Humans ; Light Coagulation/methods ; Male ; Precancerous Conditions/surgery ; Primary Health Care ; Treatment Outcome |
| Language | English |
| Publishing date | 2012-12 |
| Publishing country | United States |
| Document type | Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 212581-x |
| ISSN | 1530-0358 ; 0012-3706 |
| ISSN (online) | 1530-0358 |
| ISSN | 0012-3706 |
| DOI | 10.1097/DCR.0b013e31826d5cb5 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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