Comparison of imiquimod, topical fluorouracil, and electrocautery for the treatment of anal intraepithelial neoplasia in HIV-positive men who have sex with men: an open-label, randomised controlled trial

Treatment of anal dysplasia in HIV-positive men who have sex with men in a large AIDS reference centre

“…This study showed response rates (recovery or regression) of 35% for imiquimod, 30% for 5-FU and 46% for ECA. 28 ECA resulted in significantly more complete responses than 5-FU (p = 0.008), but not compared with imiquimod (p = 0.1). 28 In our study, the different treatments used had comparable response rates, except for the combination of ECA and surgical resection that gave poorer results.…”

“…28 ECA resulted in significantly more complete responses than 5-FU (p = 0.008), but not compared with imiquimod (p = 0.1). 28 In our study, the different treatments used had comparable response rates, except for the combination of ECA and surgical resection that gave poorer results. However, our study was not randomised, and the choice of treatment was based on the size, number, location, grade of dysplastic lesions and patient preference.…”

HIV-Associated Anal Dysplasia and Anal Carcinoma

“…In a prospective comparative trial, local eradication of HPV-associated anogenital lesions with electrocautery was superior to topical immunotherapy with imiquimod or with local chemotherapy in HIV-positive MSM [47]. In daily routine, electrocautery or argon plasma coagulation are performed as a first-line treatment for condylomata acuminata and AIN [48].…”

“…Intra-anal imiquimod-containing suppositories could eradicate AIN in up to 74% and reduce HPV positivity after 12-16 weeks of treatment [53,54]. The randomized prospective trial in HIV-positive individuals shows a much lower efficacy of imiquimod of 24% [47]. Again, the problem of recurrence cannot be overcome by imiquimod [55,56].…”

Anal Cancer

“…Recently a randomized controlled trial of 156 patients with ASIL comparing imiquimod, topical 5-fluorouracil, and electrocautery showed that of the three modalities, electrocautery was the most effective for intra-anal lesions. However, each modality was associated with a high risk of lesion recurrence (Richel et al 2013). There was little difference between the modalities for treatment of perianal ASIL.…”