title: Topical application of trichloroacetic acid is efficacious for the treatment of internal anal high-grade squamous intraepithelial lesions in HIV-positive men.
abstract: OBJECTIVE
  To assess the efficacy of topical 80% trichloroacetic acid (TCA) to treat internal anal high-grade squamous intraepithelial lesions (HSILs) in HIV-positive individuals.
  
  
  METHODS
  All patients who attended the University of Pittsburgh Anal Dysplasia Clinic for treatment of biopsy-proven internal anal HSIL with topical TCA between July 1, 2009, and June 30, 2012, and who had 1 or more follow-up visits to assess treatment efficacy were included in the analysis. Recurrence of HSIL was assessed in July 1, 2013.
  
  
  RESULTS
  A total of 98 HSILs from 72 patients were treated, and 77 (78.6%) resolved to normal epithelium or low-grade SIL during follow-up. Forty-eight (49.0%) and 27 (27.6%) of lesions resolved with 1 and 2 TCA treatments, respectively, whereas 1 lesion (1%) each resolved with 3 and 4 TCA treatments. Twenty-one (21.4%) lesions in 20 patients remained without resolution after TCA treatments. These patients were offered an alternative treatment. During follow-up, 8 (15.1%) of 53 patients had a lesion that recurred at the index site (11/53 [20.8%], inclusive of adjacent lesions) and 17 patients had new lesions diagnosed.
  
  
  CONCLUSIONS
  Topical TCA is an efficacious treatment of internal anal HSIL in an anal dysplasia clinic setting with high-resolution anoscopy capacity. Advantages of TCA for this recurrent disease process include the following: low cost, no requirement for special equipment beyond that for high-resolution anoscopy, and painless application procedure. A larger prospective comparative study would better define efficacy and patient acceptability between treatment methods.
authors.affiliation: From the *Department of Medicine, University of Pittsburgh, Pittsburgh, PA; †University of Pittsburgh Medical Center, Pittsburgh, PA; ‡Statistics Consulting Laboratory, Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA; and §Department of Pathology at Magee-Womens Hospital, Pittsburgh, PA.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Cranston
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Baker
authors.forename: Yimeng
authors.initials: Y
authors.lastname: Liu
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.forename: Esther
authors.initials: E
authors.lastname: Elishaev
authors.forename: Ken S
authors.initials: KS
authors.lastname: Ho
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000276:immunology / Q000473:pathology*; D001005:Anus Neoplasms / Q000473:pathology / Q000517:prevention & control*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000517:prevention & control*; D002424:Caustics / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000276:immunology / Q000473:pathology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D054526:Men's Health; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011351:Proctoscopy; D012189:Retrospective Studies; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000517:prevention & control; D016896:Treatment Outcome; D014238:Trichloroacetic Acid / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D002424:Caustics; D014238:Trichloroacetic Acid