title: Treatment of high-grade anal intraepithelial neoplasia with infrared coagulation in a primary care population of HIV-infected men and women.
abstract: BACKGROUND
  High-grade anal intraepithelial neoplasia, the putative anal carcinoma precursor, is more common in HIV-infected persons. The ideal treatment for these lesions has not been established.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the effectiveness of infrared coagulation treatment for high-grade anal intraepithelial neoplasia.
  
  
  METHODS
  This is a prospective cohort study. Patients with high-grade anal intraepithelial neoplasia either received infrared coagulation treatment or voluntarily did not receive treatment and were reevaluated at a subsequent time point.
  
  
  METHODS
  This investigation was performed at a Ryan White-funded clinic located in the United States.
  
  
  METHODS
  HIV-infected men and women with biopsy-confirmed high-grade anal intraepithelial neoplasia were included.
  
  
  METHODS
  The primary outcome measured was the histology collected by high-resolution anoscopy-directed biopsy.
  
  
  RESULTS
  The study included 124 patients. Of 42 patients who either delayed treatment or were not treated, 37 (88%; 95% CI = 74%-96%) still had high-grade anal intraepithelial neoplasia on reevaluation and 2 (5%; 95%CI = 1%-16%) had squamous-cell carcinoma. Of 98 patients who received infrared coagulation treatment, 73 (74%; 95% CI = 65%-83%) patients had no evidence of high-grade anal intraepithelial neoplasia on their first posttreatment evaluation, and none had progressed to squamous-cell carcinoma (p < 0.0001 in comparison with untreated). Upon completing all initial and, if necessary, follow-up treatment, 85 (87%; 95% CI = 78%-93%) patients treated by infrared coagulation had no evidence of high-grade anal intraepithelial neoplasia and none had progressed to squamous-cell carcinoma.
  
  
  CONCLUSIONS
  The study population may not be representative of the general population, the study environment was uncontrolled, and patients were not randomly assigned to treatment.
  
  
  CONCLUSIONS
  Infrared coagulation is an effective treatment for high-grade anal intraepithelial neoplasia.
authors.affiliation: Dermatology Division, Department of Internal Medicine, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas 76107, USA. weistephen@me.com
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Weis
authors.forename: Isabel
authors.initials: I
authors.lastname: Vecino
authors.forename: Janice M
authors.initials: JM
authors.lastname: Pogoda
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Susa
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001004:Anus Diseases / Q000601:surgery*; D001706:Biopsy; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008028:Light Coagulation / Q000379:methods*; D008297:Male; D011230:Precancerous Conditions / Q000601:surgery*; D011320:Primary Health Care; D016896:Treatment Outcome