Prevalence of perianal intraepithelial neoplasia in HIV-infected patients referred for high-resolution anoscopy.
OBJECTIVE
This study was designed to describe perianal disease in a cohort of HIV-infected patients referred for high-resolution anoscopy.


METHODS
A retrospective chart review was performed on 52 HIV-infected patients referred for high-resolution anoscopy from 2001 to 2005. All patients underwent anal canal and perianal high-resolution anoscopy in the office with biopsy of suspicious areas. Patients with high-grade intraepithelial perianal lesions underwent multiple biopsies under general anesthesia in the operating room to rule out malignancy.


RESULTS
Of the 52 patients, 19 (37 percent) had perianal abnormalities noted on high-resolution anoscopy and underwent punch biopsy. The mean duration of known HIV infection in these 19 patients (15 males) was 10.6 years, with 17 on highly active antiretroviral therapy for the last 3-month period. Mean CD4 count was 371 cells/microl. Office perianal biopsies diagnosed two patients with invasive squamous-cell carcinoma and nine with high-grade squamous intraepithelial lesion. Seven of the nine patients with perianal high-grade squamous intraepithelial lesion on office biopsy were submitted to multiple biopsies under general anesthesia. One of these seven had an occult perianal squamous-cell carcinoma.


CONCLUSIONS
Perianal disease was common in this group of HIV-infected patients; 11 patients (21 percent of total) were diagnosed with squamous-cell carcinoma or high-grade squamous intraepithelial lesion. Because only 19 patients had clinically suspicious perianal lesions biopsied, this may be an underestimate. Our data suggest that anal canal neoplasia often is accompanied by perianal disease and illustrates the need for biopsy of any suspicious perianal lesions.
Nahas
Caio S R
CS
Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Lin
Oscar
O
Weiser
Martin R
MR
Temple
Larissa K
LK
Wong
W Douglas
WD
Stier
Elizabeth A
EA
D000328:Adult; D001005:Anus Neoplasms / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D018791:CD4 Lymphocyte Count; D002278:Carcinoma in Situ / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D003218:Condylomata Acuminata / Q000209:etiology / Q000473:pathology / Q000628:therapy; D003581:Cytodiagnosis; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011351:Proctoscopy / Q000379:methods*; D012189:Retrospective Studies