title: Treatment of high-grade anal dysplasia in high-risk patients: outcome at an urban community health centre.
abstract: 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. One hundred and fifty-three met inclusion criteria; 86 (56%) were HIV-infected. Eighty (52%) received outpatient ablation, 49 (61%) had a follow-up within nine 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 versus 2, 3 or 4 quadrants) at the time of treatment 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.
authors.affiliation: Department of Medicine, Section of Infectious Diseases, Boston Medical Center, 850 Harrison Avenue, Dowling Ground, Boston, MA 02118.
authors.forename: S A
authors.initials: SA
authors.lastname: Assoumou
authors.forename: L A
authors.initials: LA
authors.lastname: Panther
authors.forename: Y
authors.initials: Y
authors.lastname: Feng
authors.forename: R S
authors.initials: RS
authors.lastname: Gelman
authors.forename: D K
authors.initials: DK
authors.lastname: Fugelso
authors.forename: K H
authors.initials: KH
authors.lastname: Mayer
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D001900:Boston / Q000453:epidemiology; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D003151:Community Health Centers; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D053685:Laser Therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012725:Sexual Behavior; D016896:Treatment Outcome; D014505:Urban Population
keywords: AIN; HGAIN treatment; HIV/AIDS; HPV; MSM; high-grade anal intraepithelial neoplasia; homosexual; human papillomavirus
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