Brief Report: Effectiveness of Trichloroacetic Acid vs. Electrocautery Ablation for the Treatment of Anal High-Grade Squamous Intraepithelial Lesion in HIV-Infected Patients

Abstract

Our study showed a higher efficacy of TCA than ECA with similar rates of side effects. In our opinion, considering the benefits of TCA, it should be considered as a first-line therapy for most anal HSIL management.

Short-term effectiveness and tolerability of carbon dioxide laser for anal high-grade squamous intraepithelial lesions in individuals living with HIV

“…Recently, Burgos et al reported a total response (CR + PR) of 61% and 84% after one cycle of treatment of EC and TCA respectively in a population of MSM living with HIV. 14 Other studies have analyzed response rates in different populations with a combination of treatment criteria and ablative methods which makes it difficult to compare with our results. In our series, 53.8% of all patients had a history of previous anal dysplasia (67.8% of them, anal HSIL) which may have a negative impact on treatment efficacy as having multiple HSIL has been associated with poor response to other ablative treatments.…”

“…12 The group of Burgos et al observed that tolerability considered as good in 79.4% and 85.5% of cases treated with EC and TCA respectively. 14 Other aspects of treatment tolerability have been less well explored, indeed, significant impairment of health-related quality of life and sexual functioning associated with EC has been reported compared to topical treatments. 38 In our series, 69.4% of the patients who were assessed for AEs did not report any kind of discomfort, pain or bleeding either during or after treatment despite the fact that it was performed in all cases without prior local anaesthesia.…”

“…6 Minimally invasive ablative procedures such as electrocoagulation (EC), infra-red coagulation (IRC) and application of trichloroacetic acid (TCA) are the most commonly used treatment modalities. [7][8][9] Previous prospective and observational studies on ablative procedures' efficacy for treating these lesions have shown response rates that range from 21% to 80% [10][11][12][13][14][15] with recurrence rates varying from 14% to as high as 79%. [10][11][12][13][14][15][16] The measurement of safety and tolerability of these ablative treatments has frequently not been recorded systematically or consistently but commonly includes pain and bleeding at the treatment site.…”

“…[7][8][9] Previous prospective and observational studies on ablative procedures' efficacy for treating these lesions have shown response rates that range from 21% to 80% [10][11][12][13][14][15] with recurrence rates varying from 14% to as high as 79%. [10][11][12][13][14][15][16] The measurement of safety and tolerability of these ablative treatments has frequently not been recorded systematically or consistently but commonly includes pain and bleeding at the treatment site. 12,14 These local and occasionally systemic adverse events (AEs) may have an impact on treatment adherence and subsequent response as frequently more than one treatment session is necessary to ablate HSIL/s.…”

“…[10][11][12][13][14][15][16] The measurement of safety and tolerability of these ablative treatments has frequently not been recorded systematically or consistently but commonly includes pain and bleeding at the treatment site. 12,14 These local and occasionally systemic adverse events (AEs) may have an impact on treatment adherence and subsequent response as frequently more than one treatment session is necessary to ablate HSIL/s.…”