Response factors associated with electrocautery treatment of intra-anal high-grade squamous intraepithelial lesions in a population of HIV-positive men who have sex with men.
BACKGROUND
Ablative treatment of anal high-grade squamous intraepithelial lesions (HSIL) reduces the risk of progression to anal squamous cell carcinoma.


OBJECTIVES
To identify factors that influence the response to treatment of anal HSIL by electrocautery ablation (ECA) in a population of HIV-positive men who have sex with men (MSM).


DESIGN
Retrospective study of ECA treatment response in a prospectively followed anal dysplasia cohort. HIV-positive MSM diagnosed with anal HSIL were included. Demographic and HIV data were recorded. Response to treatment was assessed by biopsy after at least 18 months of follow-up.


RESULTS
One hundred and twenty-eight HSILs in 91 men were included in this study. The overall response rate at 18 months was 70.3%. The number of electrocautery sessions required (2 ECA sessions vs 1: adjusted odds ratio [aOR] = 0.36 (95%CI 0.13-1.01); >=3 sessions vs 1: aOR = 0.10 (95%CI 0.04-0.29); p < 0.001]) and the history of previous HPV-related anal pathology (previous anal lesions vs no previous lesions AOR = 2.83 (95%CI 1.14-7.02), p = 0.024) were independently associated with response at 18 months. No serious adverse events were reported.


CONCLUSIONS
Consideration should be given to alternative therapies in patients with unresolved HSIL after 1 ECA treatment.
['Fuertes|Irene|I|0000-0002-9314-1843', 'Cranston|Ross|R|', 'de Lazzari|Elisa|E|', 'Rodriguez-Carunchio|Leonardo|L|', 'Blanco|José L|JL|']
D001005:Anus Neoplasms D004564:Electrocoagulation D015658:HIV Infections D018451:Homosexuality, Male D006801:Humans D008297:Male D030361:Papillomavirus Infections D012189:Retrospective Studies D000072339:Sexual and Gender Minorities D000081483:Squamous Intraepithelial Lesions
electrocautery Anal high-grade squamous intraepithelial lesions high-resolution anoscopy human immunodeficiency virus human papillomavirus