Elizabeth A Stier1, Wafaa Abbasi1, Amma F Agyemang1,2, Eduardo Amílkar Valle Álvarez1,3, Elizabeth Y Chiao4,5, Ashish A Deshmukh6. 1. Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, Boston, MA. 2. Currently, Center for Immunotherapy, Roswell Park Comprehensive Cancer Center, Buffalo, NY. 3. Currently, Keck School of Medicine of the University of Southern California, Los Angeles, CA. 4. Section Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX. 5. Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA; and. 6. Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX.
Abstract
BACKGROUND: Women living with HIV (WLHIV) have a high risk of developing invasive anal cancer. Anal cancer may be prevented with early detection and treatment of anal histologic high-grade squamous intraepithelial lesions (HSIL). However, there are limited data on the efficacy of anal HSIL treatment in WLHIV. STUDY DESIGN: We conducted a retrospective study of WLHIV treated for anal HSIL under high-resolution anoscopy (HRA) guidance from January 1, 2007 to December 31, 2017 with at least one post-treatment visit at an urban tertiary care hospital. RESULTS: Forty-five WLHIV women with at least 1 follow-up evaluation after treatment for anal HSIL were identified. The median age was 46 years (range 35-66 years), 63% were African American, 27% were Hispanic/Latino, and 53% were current smokers. The mean absolute CD4 T-cell count was 516 cells/mm; 50% and 24% of the cohort had a history of cervical or vulvar HSIL respectively. The cumulative probability of anal HSIL recurrence was 29% at 12 months, 52% at 24 months, and 79% at 36 months post-treatment. CONCLUSION: Most WLHIV treated for anal HSIL recurred within 3 years, suggesting need for continued surveillance after treatment. Our data contribute to the information needed to develop effective anal cancer prevention guidelines in WLHIV.
BACKGROUND:Women living with HIV (WLHIV) have a high risk of developing invasive anal cancer. Anal cancer may be prevented with early detection and treatment of anal histologic high-grade squamous intraepithelial lesions (HSIL). However, there are limited data on the efficacy of anal HSIL treatment in WLHIV. STUDY DESIGN: We conducted a retrospective study of WLHIV treated for anal HSIL under high-resolution anoscopy (HRA) guidance from January 1, 2007 to December 31, 2017 with at least one post-treatment visit at an urban tertiary care hospital. RESULTS: Forty-five WLHIV women with at least 1 follow-up evaluation after treatment for anal HSIL were identified. The median age was 46 years (range 35-66 years), 63% were African American, 27% were Hispanic/Latino, and 53% were current smokers. The mean absolute CD4 T-cell count was 516 cells/mm; 50% and 24% of the cohort had a history of cervical or vulvar HSIL respectively. The cumulative probability of anal HSIL recurrence was 29% at 12 months, 52% at 24 months, and 79% at 36 months post-treatment. CONCLUSION: Most WLHIV treated for anal HSIL recurred within 3 years, suggesting need for continued surveillance after treatment. Our data contribute to the information needed to develop effective anal cancer prevention guidelines in WLHIV.
Authors: Eva Clark; Liang Chen; Yongquan Dong; Suchismita Raychaudhury; Donna White; Jennifer R Kramer; Elizabeth Chiao Journal: Clin Infect Dis Date: 2021-05-04 Impact factor: 9.079
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