title: Health-Related Quality of Life and Sexual Functioning of HIV-Positive Men Who Have Sex With Men Who Are Treated for Anal Intraepithelial Neoplasia.
abstract: BACKGROUND
  The impact of the treatment of precursor lesions of anal cancer (anal intraepithelial neoplasia) on health-related quality of life has not been investigated.
  
  
  OBJECTIVE
  This study aimed to evaluate the impact of 3 treatment options for anal intraepithelial neoplasia on health-related quality of life and sexual functioning in HIV-positive men who have sex with men.
  
  
  METHODS
  The prospective cohort was embedded in a randomized clinical trial evaluating the optimal treatment of anal intraepithelial neoplasia.
  
  
  METHODS
  This study was performed at the HIV outpatient clinic of the Academic Medical Center, Amsterdam, the Netherlands.
  
  
  METHODS
  Included in the study were HIV-positive men who have sex with men with anal intraepithelial neoplasia.
  
  
  METHODS
  Treatment with imiquimod (n = 54), topical fluorouracil (n = 48), or electrocautery (n = 46) was given for 16 weeks.
  
  
  METHODS
  Health-related quality of life and sexual functioning were assessed before, during, and 4 weeks after treatment. Health-related quality of life was assessed using the EQ5D, sexual functioning was assessed using items derived from the International Index of Erectile Function, and the female sexual function index adapted for anal intercourse.
  
  
  RESULTS
  One hundred forty-five patients (98%) completed at least 1 questionnaire. There was a significant different pattern of change over time in health-related quality of life among the 3 treatment groups. Patients in the imiquimod group were more likely to report pain/discomfort at week 8 than patients in the electrocautery group. Patients in the electrocautery group were more likely to report anxiety/depression and were less satisfied with their overall sex life at week 16 than patients in the imiquimod and fluorouracil groups, and patients in the electrocautery group were also more likely to report pain/discomfort and problems with usual activities at week 20 than patients in the fluorouracil group.
  
  
  CONCLUSIONS
  The follow-up method differed slightly among treatment groups. There is no standardized, validated sexual functioning questionnaire for HIV-positive men who have sex with men.
  
  
  CONCLUSIONS
  All treatment options have a negative impact on aspects of health-related quality of life. Electrocautery has significantly more negative effects on health-related quality of life than imiquimod and fluorouracil and also has a negative effect on sexual functioning.
authors.affiliation: 1 Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands 2 Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands 3 Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands 4 Department of Psychology, Academic Medical Center, Amsterdam, The Netherlands 5 Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.
authors.forename: Matthijs L
authors.initials: ML
authors.lastname: Siegenbeek van Heukelom
authors.forename: Olivier
authors.initials: O
authors.lastname: Richel
authors.forename: Pythia T
authors.initials: PT
authors.lastname: Nieuwkerk
authors.forename: Henry J C
authors.initials: HJ
authors.lastname: De Vries
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins