Topical Application of Trichloroacetic Acid Is Efficacious for the Treatment of Internal Anal High-Grade Squamous Intraepithelial Lesions in HIV-Positive Men

OBJECTIVESTo assess the efficacy of topical 80% trichloroacetic acid (TCA) to treat internal anal high-grade squamous intraepithelial lesions (HSILs) in HIV-positive individuals. METHODSAll patients who attended the University of Pittsburgh Anal Dysplasia Clinic for treatment of biopsy-proven intern...

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Bibliographic Details
Published in:Sexually transmitted diseases 2014-07, Vol.41 (7), p.420-426
Main Authors: Cranston, Ross D., Baker, Jonathan R., Liu, Yimeng, Wang, Lu, Elishaev, Esther, Ho, Ken S.
Format: Article
Language:English
Subjects:
Acids
Administration, Topical
Adult
Aged
Anal Canal - immunology
Anal Canal - pathology
Anus Neoplasms - pathology
Anus Neoplasms - prevention & control
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - prevention & control
Caustics - administration & dosage
Caustics - therapeutic use
Clinics
Comparative analysis
Dysplasia
Efficacy
Female
Follow-Up Studies
HIV
HIV Seropositivity - immunology
HIV Seropositivity - pathology
Human immunodeficiency virus
Humans
Lesions
Male
Mass Screening
Medical diagnosis
Medical treatment
Men
Men's Health
Middle Aged
Neoplasm Recurrence, Local - prevention & control
Original Study
Proctoscopy
Retrospective Studies
Squamous Intraepithelial Lesions of the Cervix - drug therapy
Squamous Intraepithelial Lesions of the Cervix - immunology
Squamous Intraepithelial Lesions of the Cervix - pathology
Squamous Intraepithelial Lesions of the Cervix - prevention & control
Treatment Outcome
Trichloroacetic Acid - administration & dosage
Trichloroacetic Acid - therapeutic use
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Summary:OBJECTIVESTo assess the efficacy of topical 80% trichloroacetic acid (TCA) to treat internal anal high-grade squamous intraepithelial lesions (HSILs) in HIV-positive individuals. METHODSAll patients who attended the University of Pittsburgh Anal Dysplasia Clinic for treatment of biopsy-proven internal anal HSIL with topical TCA between July 1, 2009, and June 30, 2012, and who had 1 or more follow-up visits to assess treatment efficacy were included in the analysis. Recurrence of HSIL was assessed in July 1, 2013. RESULTSA total of 98 HSILs from 72 patients were treated, and 77 (78.6%) resolved to normal epithelium or low-grade SIL during follow-up. Forty-eight (49.0%) and 27 (27.6%) of lesions resolved with 1 and 2 TCA treatments, respectively, whereas 1 lesion (1%) each resolved with 3 and 4 TCA treatments. Twenty-one (21.4%) lesions in 20 patients remained without resolution after TCA treatments. These patients were offered an alternative treatment. During follow-up, 8 (15.1%) of 53 patients had a lesion that recurred at the index site (11/53 [20.8%], inclusive of adjacent lesions) and 17 patients had new lesions diagnosed. CONCLUSIONSTopical TCA is an efficacious treatment of internal anal HSIL in an anal dysplasia clinic setting with high-resolution anoscopy capacity. Advantages of TCA for this recurrent disease process include the followinglow cost, no requirement for special equipment beyond that for high-resolution anoscopy, and painless application procedure. A larger prospective comparative study would better define efficacy and patient acceptability between treatment methods.
ISSN:0148-5717
1537-4521
DOI:10.1097/olq.0000000000000145