title: The effectiveness of electrocautery ablation for the treatment of high-grade anal intraepithelial neoplasia in HIV-infected men who have sex with men.
abstract: Electrocautery is one of the main treatment options for high-grade anal intraepithelial neoplasia (HGAIN). However, data regarding its efficacy are scarce. The aim of the study was to evaluate the effectiveness of electrocautery for the treatment of HGAIN.
  
  
  
  An observational study of HIV-infected men who have sex with men (MSM) who underwent screening for anal dysplasia was carried out. The on-treatment effectiveness of electrocautery was evaluated (according to biopsy findings measured 6-8 weeks after treatment) in patients with HGAIN. A complete response was defined as resolution of anal intraepithelial neoplasia (AIN), a partial response as regression to low-grade AIN and recurrence as biopsy-proven HGAIN during follow-up.
  
  
  
  From May 2009 to November 2014, 21.9% (126 of 576) of patients screened were found to have HGAIN. Electrocautery effectiveness was evaluated in 83 patients. A complete response was observed in 27 patients [32.5%; 95% confidence interval (CI) 23.4-53.2%], a partial response in 28 patients (33.7%; 95% CI 24.5-44.4%) and persistence in 28 patients (33.7%; 95% CI 24.5-44.4%). The patients with the most successful results (81.8%) required two to four sessions of electrocautery. After a mean follow-up of 12.1 months, 14 of 55 patients with a response (25.4%; 95% CI 15.8-38.3%) developed recurrent HGAIN within a mean time of 29.9 months (95% CI 22-37.7 months). No patient progressed to invasive cancer during the study or developed serious adverse events after treatment. No factors associated with poor response or recurrences were observed.
  
  
  
  Although electrocautery is the standard treatment for anal dysplasia, almost 50% of patients with HGAIN in our study did not respond or relapsed. New treatment strategies are necessary to optimize the management of anal dysplasia.
authors.affiliation: Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Burgos
authors.affiliation: Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Curran
authors.affiliation: Anatomical Pathology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Landolfi
authors.affiliation: Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Navarro
authors.affiliation: Anatomical Pathology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Tallada
authors.affiliation: Internal Medicine Department, Mar University Hospital, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Guelar
authors.affiliation: Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Crespo
authors.affiliation: Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Ocaña
authors.affiliation: Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Ribera
authors.affiliation: Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Falcó
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000628:therapy*; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D000072339:Sexual and Gender Minorities; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000628:therapy*; D016896:Treatment Outcome
keywords: anal intraepithelial neoplasia; electrocautery ablation; human papillomavirus infection