Treatment of anal dysplasia in HIV-positive men who have sex with men in a large AIDS reference centre.
OBJECTIVE
Over the last few decades, incidence of anal cancer among HIV-positive men has been on the rise. In this context, programmes of screening and treatment of anal dysplasia which is a precursor of anal cancer have been developed. The aim of our study was to describe the efficiency, side effects and outcome of anal dysplasia treatment in a population of HIV-positive men who have sex with men (MSM).


METHODS
We performed a retrospective study of HIV-positive MSM who received treatment for anal dysplasia between May 2010 and February 2014 in the Saint-Pierre University Hospital, Brussels. The different treatments used were electrocautery (ECA), infrared coagulation (IRC), surgical treatment and imiquimod.


RESULTS
Seventy-three HIV-infected MSM were included in the study, counting 62% of HGAIN. Median age was 41 years. Eighty-one per cent were on HAART. Median CD4 cell count was 525 cell/mm³, and 65% had undetectable viral loads. A total of 139 therapeutic interventions were recorded during the study period, and two-thirds of the enrolled patients received more than one treatment. At 540 days of follow-up, the rate of treatment response was 62%. Fifty per cent of the persistent HGAIN were metachronous lesions. No severe adverse events were recorded but frequent treatment-associated discomfort was reported, such as pain, self-limited bleeding, infection and anal irritation.


CONCLUSIONS
Treatment of anal dysplasia appears to be safe and to offer short-term efficiency. However, its long-term efficiency remains unknown, especially in the HIV-positive population in which spontaneous clearance is lower and rate of recurrence higher.
a Department of Infectious Disease and AIDS Reference centre , Brussels , Belgium.
Nathalie
N
Willems
a Department of Infectious Disease and AIDS Reference centre , Brussels , Belgium.
Agnès
A
Libois
b Department of Gastroenterology , Saint-Pierre University Hospital , Brussels , Belgium.
Marcel
M
Nkuize
c Department of Pathology , Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium.
Francesco
F
Feoli
a Department of Infectious Disease and AIDS Reference centre , Brussels , Belgium.
Marc
M
Delforge
a Department of Infectious Disease and AIDS Reference centre , Brussels , Belgium.
Stéphane
S
DeWit
D000328:Adult; D000634:Aminoquinolines / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000188:drug therapy / Q000601:surgery* / Q000821:virology; D002278:Carcinoma in Situ / Q000188:drug therapy / Q000601:surgery* / Q000821:virology; D005240:Feasibility Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D000077271:Imiquimod; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod
Anal dysplasia treatment; Anal intraepithelial neoplasia; HIV; MSM squamous cell anal carcinoma