title: Long-term effectiveness of infrared coagulation for the treatment of anal intraepithelial neoplasia grades 2 and 3 in HIV-infected men and women.
abstract: OBJECTIVE
  To assess the effectiveness and safety of infrared coagulation (IRC) for the ablation of anal intraepithelial neoplasia (AIN) and to provide data on the prevalence of AIN in HIV-infected patients.
  
  
  METHODS
  We performed a single-center, retrospective cohort study based on data collected from a prospectively compiled database of outpatients attended in the Clinical-Proctology-HIV-Unit (first visit). The effectiveness (normal anal cytology after 12 months of IRC) and safety of IRC were estimated.
  
  
  RESULTS
  Between January 2005 and December 2011, a total of 69 (5%) patients with biopsy-proven AIN-2 or AIN-3 from among 1518 patients (1310 men; 208 women) were treated with IRC. The prevalence of cytological abnormalities was 49.5% [751/1518; (atypical squamous cells of unknown significance, 14%; low-grade squamous intraepithelial lesions, 27.5%; high-grade squamous intraepithelial lesions, 8%)]. High-resolution anoscopy revealed intra-anal condylomata in 31% of patients (236/751), nonvisualized lesions in 30% (227/751), and visualized lesions (from which biopsy specimens were taken) in 38% (288/751). The histological diagnosis was: AIN-1, 52% (151/288); AIN-2, 15% (44/288); AIN-3, 9% (25/288); normal, 19% (56/288); and nonevaluable, 4% (12/288). IRC was applied in-office in 66 patients (three refused to undergo treatment). At 12 months, all patients (n = 56) had a normal anal cytology result. Seven (13%) patients had biopsy-proven recurrence [mean (range) time-to-recurrence, 30 (18-43) months]. High-risk-human papilloma virus (HPV) infection was detected in all anal lesions (HPV-16 was the most common genotype). Agreement between cytological and histological results was poor.
  
  
  CONCLUSIONS
  A high prevalence of AIN was found in both HIV-infected men and HIV-infected women. Although randomized clinical trials are lacking, IRC ablation of AIN-2 and AIN-3 lesions without concomitant condylomata could help prevent anal squamous cell carcinoma.
authors.affiliation: aLluita Contra La SIDA Foundation bHIV Clinical Unit, Department of Medicine cDepartment of Surgery dRetrovirology Laboratory IrsiCaixa Foundation; University Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Catalonia eLabco.GeneralLab, Barcelona fDepartment of Sanitat i Anatomia Animal, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain. *Guillem Sirera and Sebastián Videla contributed equally to the writing of this article.
authors.forename: Guillem
authors.initials: G
authors.lastname: Sirera
authors.forename: Sebastián
authors.initials: S
authors.lastname: Videla
authors.forename: Marta
authors.initials: M
authors.lastname: Piñol
authors.forename: Josep
authors.initials: J
authors.lastname: Coll
authors.forename: Francesc
authors.initials: F
authors.lastname: García-Cuyás
authors.forename: Sandra
authors.initials: S
authors.lastname: Vela
authors.forename: MariPaz
authors.initials: M
authors.lastname: Cañadas
authors.forename: Laila
authors.initials: L
authors.lastname: Darwich
authors.forename: Núria
authors.initials: N
authors.lastname: Pérez
authors.forename: Silvia
authors.initials: S
authors.lastname: Gel
authors.forename: Patricia
authors.initials: P
authors.lastname: Cobarsi
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Clotet
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000453:epidemiology / Q000628:therapy*; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D003584:Cytological Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007259:Infrared Rays; D008028:Light Coagulation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult