Long-term Follow-up of Infrared Coagulator Ablation of Anal High-Grade Dysplasia in Men Who Have Sex With Men

Background Persistent human papillomavirus infection in human immunodeficiency virus (HIV)-infected individuals has been strongly associated with anal squamous cell carcinoma. The incidence of anal squamous cell carcinoma continues to increase in this population despite advances in HIV therapy. There are few studies describing the prevalence of anal cancer precursors, treatment outcomes, and associated factors among HIV-infected populations in the southern United States. Methods A retrospective chart review was performed on 355 HIV-infected patients from a Southern HIV clinic who were 18 years or older and had received at least one anal Pap smear. Demographic and clinical variables were collected. Descriptive statistics, single variable, and multivariate logistic regression analysis were performed to evaluate for predictors of high-grade squamous intraepithelial lesion (HSIL). Odds ratios and 95% confidence intervals were constructed for independent measures. Results After the first anal Pap smear, 38.3% (70/183) of patients with abnormal results were lost to follow-up. Comparing patients with biopsy proven HSIL versus low-grade squamous intraepithelial lesions, patients were less likely to have HSIL if they had a higher CD4 count (odds ratio, 0.81; 95% confidence interval, 0.72–0.93; P = 0.0022). Treatment success after the first round of treatment for topical and infrared coagulation therapy was 36.7% (18/49, all therapy types), and of those who achieved biopsy proven treatment success at follow-up screening, 94.4% (17/18) required subsequent therapy. Conclusions Patients with a higher CD4 count were less likely to have HSIL. CD4 nadir, number of sexual partners, and race/ethnicity were not significantly associated with the presence of HSIL.

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“…Overall, the relatively high rate of recurrence of HSIL may be partially mediated by the presence of metachronous lesions. 16–18 …”

Section: Discussionmentioning

confidence: 99%

Anal Dysplasia Screening and Treatment in a Southern Human Immunodeficiency Virus Clinic

et al. 2016

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“…(6) All MSM in the vaccination group receive qHPV vaccine in addition to treatment for HGAIN. (7) The probabilities of first, second, and third recurrences after treatment for HGAIN are based on Goldstone et al [5]. (8) After every event of HGAIN recurrence, those who are not compliant with the treatment follow the natural history of the cancer and progress from having HGAIN to anal cancer at a progression rate of 1 in 4196 patients per year [2].…”

Section: Methodsmentioning

confidence: 99%

“…The removal of HGAIN is thought to prevent progression to anal cancer in almost all patients [4]. However, the recurrence rate of HGAIN is almost 62% within the first year after treatment in HIV-negative MSM [5]. …”

Section: Introductionmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of quadrivalent human papillomavirus vaccination in HIV-negative men who have sex with men to prevent recurrent high-grade anal intraepithelial neoplasia

Deshmukh¹,

Chiao²,

Das³

et al. 2014

Vaccine

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We examined the long-term clinical and economic benefits of quadrivalent human papillomavirus (qHPV) vaccine as a secondary/adjunct prevention strategy in the prevention of recurrent high-grade intraepithelial neoplasia (HGAIN) in HIV-negative men who have sex with men (MSM) and are 27 years or older. We constructed a Markov model to evaluate the clinical effectiveness and cost-effectiveness of two strategies: (1) no qHPV vaccine after treatment for HGAIN versus (2) qHPV vaccine after treatment for HGAIN. Model parameters, including natural history of anal cancer, vaccine efficacy measured in terms of hazard ratio (HR) (risk of recurrent HGAIN), HGAIN treatment efficacy, utilities, and costs, were obtained from the literature. The outcomes were measured in terms of lifetime risk of anal cancer, lifetime cost, quality-adjusted life years, and incremental cost-effectiveness ratios (ICERs). Sensitivity analysis was conducted on all model parameters. We found that vaccinating HIV-negative MSM reduced the lifetime risk of anal cancer by 60.77% at an ICER of US$87,240 (95% CI, $22,301–$144,187) per quality-adjusted life-year. The results were highly sensitive to vaccine efficacy, transition of HGAIN to anal cancer, cost of treatment for HGAIN, vaccine degree of protection over time, and the vaccine duration of protection and less sensitive to HPV clearance, cost of qHPV, and the transitions from normal to low-grade anal intraepithelial neoplasia (LGAIN) and normal to HGAIN. With an HR of 0.3, the ICER was well below a $50,000 willingness-to-pay threshold; with an HR of 0.5, the ICER was still below a threshold of $100,000. The most critical disease-related factor influencing the cost-effectiveness was the progression of HGAIN to anal cancer. At an annual transition probability below 0.001, the ICER was below $50,000. Vaccinating HIV-negative MSM treated for HGAIN decreases the lifetime risk of anal cancer and is likely to be a cost-effective intervention.

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“…Nevertheless, the rate of loss to follow-up was about 30%. 16 The same group also published on the efficacy of treatment with electrocautery ablation (ECA). In that study patients were followed for at least five months.…”

Section: Discussionmentioning

confidence: 99%

Treatment of high-grade anal dysplasia in high-risk patients: outcome at an urban community health centre

2013

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SUMMARY Human immunodeficiency (HIV)-infected patients and men who have sex with men (MSM) have a higher rate of high-grade anal intraepithelial neoplasia (HGAIN), a likely precursor to anal cancer. This retrospective study describes the outcome of treating MSM with incident biopsy-proven HGAIN in an urban community health setting with access to outpatient ablation or operative treatment. The main outcome was freedom from HGAIN at follow-up. 153 met inclusion criteria; 86 (56%) were HIV-infected. Eighty (52%) received outpatient ablation, 49(61%) had a follow-up within 9 months. Among those, 26 (53%) were free of high-grade disease, 19 (39%) had high-grade disease; and 4 (8%) had unknown grading. In a logistic regression model, a lower extent of anal disease (1 quadrant vs. 2,3, or 4 quadrants) was significantly associated with a lower probability of high-grade disease (p-value 0.04.) HGAIN could be managed in a community health setting; however, systems are needed to ensure follow-up care.

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Long-term Follow-up of Infrared Coagulator Ablation of Anal High-Grade Dysplasia in Men Who Have Sex With Men

Cited by 79 publications

References 29 publications

Anal Dysplasia Screening and Treatment in a Southern Human Immunodeficiency Virus Clinic

Anal Dysplasia Screening and Treatment in a Southern Human Immunodeficiency Virus Clinic

Clinical effectiveness and cost-effectiveness of quadrivalent human papillomavirus vaccination in HIV-negative men who have sex with men to prevent recurrent high-grade anal intraepithelial neoplasia

Treatment of high-grade anal dysplasia in high-risk patients: outcome at an urban community health centre

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