Brief Report: Recurrence of Anal High-Grade Squamous Intraepithelial Lesions Among Women Living With HIV

Abstract

Background-Women living with HIV (WLHIV) have a high risk of developing invasive anal cancer. Anal cancer may be prevented with early detection and treatment of anal histologic highgrade squamous intraepithelial lesions (HSIL). However, there is limited data on the efficacy of anal HSIL treatment in WLHIV.Study Design-We conducted a retrospective study of WLHIV treated for anal HSIL under high resolution anoscopy (HRA) guidance from January 1st, 2007 to December 31st, 2017 with at least one post treatment visit at an urban tertiary care hospital.

A Prospective, Dual-Center Trial of Circumferential Radiofrequency Ablation of Anal High-Grade Squamous Intraepithelial Lesions Demonstrate Improved Long-term Efficacy Over Historical Controls of Targeted Ablation

“…16 A series of targeted ablation of HSIL in women living with HIV also reported approximately 60% recurrence at 30 months. 19 After electrocautery-targeted ablation, the predicted HSIL recurrence was approximately 70% in PLWH. 13…”

“…16 A series of targeted ablation of HSIL in women living with HIV also reported approximately 60% recurrence at 30 months. 19 After electrocautery-targeted ablation, the predicted HSIL recurrence was approximately 70% in PLWH. 13 Most series reporting probability of recurrence after targeted ablation identify a plateauing of recurrence, which also occurs after cRFA.…”

“…Ablation of anal HSIL with electrocautery or infrared coagulation (IRC) is probably the mainstay HSIL treatment. [7][8][9][12][13][14][15][16][17][18][19][20][21] Ablative therapies use HRA-guided identification and targeted destruction of individual HSILs. With the hope of diminishing recurrence, we used widefield ablation of the anal canal targeting both identifiable HSIL and seemingly normal The initial trial was small (10 participants) and conducted in single center with only a 12-month follow-up.…”

The other side of screening: predictors of treatment and follow-up for anal precancers in a large health system

“…The tradeoff to this approach is substantial post-treatment recurrence; our cohort noted at a median of 12.2 months that 45% of patients had local recurrence and 60% had recurrence of any type [15]. These high rates of recurrence make ongoing surveillance following diagnosis and treatment all the more important [15,[17][18][19][20].…”