title: Imiquimod 5% cream for five consecutive days a week in an HIV-infected observational cohort up to 32 weeks in the treatment of high-grade squamous intraepithelial lesions.
abstract: OBJECTIVE
  The incidence of anal cancer is increasing especially in HIV-positive men having sex with men. Screening for the cancer precursor, high-grade squamous intraepithelial lesions (HSIL), is challenging, as current treatment is suboptimal. The aim of this prospective study was to establish the efficacy of five consecutive days a week self-administered treatment with imiquimod 5% cream for both perianal and intra-anal HSIL and to assess the adverse effects and burden of this regimen.
  
  
  METHODS
  44 patients with histologically proved perianal or intra-anal HSIL were treated with a five consecutive days a week imiquimod 5% cream regimen. When no response could be confirmed after the first 16 weeks of therapy, patients were encouraged to continue the use of the cream for a further 16 weeks. Side effects were routinely assessed.
  
  
  RESULTS
  Complete or partial response was observed in 20 (45%) of 44 patients with HSIL after 16 weeks of treatment; another nine patients showed complete or partial response after an additional 16 weeks of treatment, resulting in a response rate of 29 (66%) out of 44 patients.
  
  
  CONCLUSIONS
  Topical imiquimod 5% cream is useful in HSIL. A five consecutive days treatment regimen with imiquimod 5% cream for HSIL does not seem to be more effective compared with the customary prescription for 3 days a week. A prolonged course of imiquimod 5% cream is warranted for intra-anal HSIL. Adverse effects are comparable between 3 and 5 days treatment regimen.
authors.affiliation: Department of Dermatology and Venereology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Eric Martin
authors.initials: EM
authors.lastname: van der Snoek
authors.affiliation: Department of Pathology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Jan Christiaan
authors.initials: JC
authors.lastname: den Hollander
authors.affiliation: Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Marchina Elisabeth
authors.initials: ME
authors.lastname: van der Ende
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000287:Administration, Topical; D000634:Aminoquinolines / Q000008:administration & dosage*; D001003:Anal Canal / Q000187:drug effects* / Q000473:pathology / Q000821:virology; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001005:Anus Neoplasms / Q000473:pathology / Q000517:prevention & control* / Q000821:virology; D018450:Disease Progression; D004564:Electrocoagulation; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000077271:Imiquimod; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009824:Ointments; D027383:Papillomaviridae / Q000472:pathogenicity; D011446:Prospective Studies; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000188:drug therapy* / Q000473:pathology / Q000821:virology
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000970:Antineoplastic Agents; D009824:Ointments; D000077271:Imiquimod
keywords: ANOGENITAL CANCER; GAY MEN; HIV; HPV; THERAPY