Establishing an anal dysplasia clinic for HIV-infected men: initial experience.
Anal dysplasia caused by human papillomavirus (HPV) infection is common in the HIV-infected population and is a precursor to squamous cell carcinoma of the anus (SCCA). Herein, we describe our initial experience in assessing the frequency and severity of anal intraepithelial neoplasia (AIN) in a newly formed anal dysplasia clinic in Seattle. During a 7-month period, 150 HIV-positive men were evaluated by digital rectal examination and high-resolution anoscopy (HRA). Forty-seven patients of the 122 patients who underwent biopsy (39%) had biopsy-identified low-grade AIN, and 47 (39%) had high-grade AIN (HGAIN). Two patients with HGAIN were referred for surgical treatment and were further noted to have microinvasive SCCA. No patient reported significant post-HRA biopsy complications. Patient tolerance and acceptance of AIN screening was good, and the majority of those who underwent screening have been adherent to recommended follow-up examinations and treatment. The clinic is expanding rapidly, with excellent community and provider support. We anticipate that the anal dysplasia clinic will enable our institution to participate in emerging HIV- and HPV-related AIN clinical trials.
Siekas
Lacey L
LL
Division of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA.
Aboulafia
David M
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D012307:Risk Factors; D013997:Time Factors; D014861:Washington / Q000453:epidemiology; D055815:Young Adult