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Article << Previous     |     Next >>   Contents Vol 9(6)

Treatment options for anal intraepithelial neoplasia and evidence for their effectiveness

Paul A. Fox A

Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. Email: paul.fox@eht.nhs.uk

Sexual Health 9(6) 587-592 http://dx.doi.org/10.1071/SH11157
Submitted: 10 November 2011  Accepted: 16 March 2012   Published: 10 August 2012


 
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Abstract

There is a growing range of treatment options for anal intraepithelial neoplasia (AIN). In HIV-positive patients, sustained treatment is often required to achieve clearance. The treatments considered are topically applied fluorouracil, imiquimod, cidofovir and trichloroacetic acid, the potential treatments of topical lopinavir and photodynamic therapy with aminolevulenic acid, and the surgical methods of electrosurgery, infrared coagulation and laser. Destructive treatment methods, possibly including TCA, are more effective than self applied topical treatments. Combining or alternating different treatments should be considered.

Additional keywords: electrosurgery, fluorouracil, imiquimod, infrared coagulation, photodynamic therapy, trichloroacetic acid.


References

[1]  Jay N, Berry JM, Darragh T, Palefsky J. Treatment of diffuse high grade anal intraepithelial neoplasia with 5% fluorouracil cream. 25th International Papillomavirus Conference; May 8-14 2009; Malmo, Sweden. P19.16.

[2]  Richel O, Wieland U, de Vries HJC, Brockmeyer NH, van Noesel C, Potthoff A, et al Topical 5-fluorouracil treatment of anal intraepithelial neoplasia in HIV positive men. Br J Dermatol 2010; 163: 1301–7.
CrossRef | CAS | PubMed |

[3]  Wieland U, Brockmeyer NH, Weissenborn SJ, Hochdorfer B, Stücker M, Swoboda J, et al Imiquimod treatment of anal intraepithelial neoplasia in HIV positive men. Arch Dermatol 2006; 142: 1438–44.
CrossRef | CAS | PubMed |

[4]  Kreuter A, Potthoff A, Brockmeyer NH, Gamichler T, Stücker M, Altmeyer P, et al Imiquimod leads to a decrease of human papillomavirus DNA and to a sustained clearance of anal intraepithelial neoplasia in HIV infected men. J Invest Dermatol 2008; 128: 2078–83.
CrossRef | CAS | PubMed |

[5]  Fox PA, Nathan M, Francis N, Singh N, Weir J, Dixon G, et al A double blind randomized controlled trial of the use of imiquimod cream for the treatment of anal canal high grade anal intraepithelial neoplasia in HIV positive MSM on HAART, with long term follow up data including the use of open label imiquimod. AIDS 2010; 24: 2331–5.
| CAS | PubMed |

[6]  Singh JC, Kuohung V, Palefsky JM. Efficacy of trichloroacetic acid in the treatment of anal intraepithelial neoplasia in HIV positive and HIV negative men who have sex with men. J Acquir Immune Defic Syndr 2009; 52: 474–9.
| CAS | PubMed |

[7]  Stier E, Goldstone S, Einstein M, Jay N, Berry M, Wilkin T, et al. Topical cidofovir for high grade perianal dysplasia in HIV positive individuals. Abstract O 19.07. 27th International Papillomavirus Conference; Sept 2011; Berlin, Germany.

[8]  Calista D. Topical cidofovir for erythroplasia of queyrat of the glans penis. Br J Dermatol 2002; 147: 399–400.
CrossRef | CAS | PubMed |

[9]  Van Pachterbeke C, Bucella D, Rozenberg S, Manigart Y, Gilles C, Larsimont D, et al Topical treatment of CIN2+ by cidofovir: results of a phase 2 double blind prospective placebo controlled study. Gynecol Oncol 2009; 115: 69–74.
CrossRef | CAS | PubMed |

[10]  Webber J, Fromm D. Photodynamic therapy for carcinoma in situ of the anus. Arch Surg 2004; 139: 259–61.
CrossRef | CAS | PubMed |

[11]  Kruijt B, van der Snoek EM, Sterenborg JCM, Amelink A, Robinson DJ. A dedicated applicator for light delivery and monitoring of PDT of anal intraepithelial neoplasia. Photodiagn Photodyn Ther 2010; 7: 3–9.
CrossRef | CAS |

[12]  van der Snoek EM, Amelink A, van der Ende ME, den Hollander JC, Kroon FP, Vriesendorp R, et al Photodynamic therapy with topical metatetrahydrochlorin is inefffective for the treatment of anal intraepithelial neoplasia grade III. J Acquir Immune Defic Syndr 2009; 52: 141–3.
CrossRef | PubMed |

[13]  Gattai R, Torchia D, Salvini C, Magini B, Comacchi C, Cappuccini A, et al Photodynamic therapy for the treatment of endoanal condylomata acuminata. Clin Infect Dis 2010; 51: 1222–3.
CrossRef | PubMed |

[14]  Zehbe I, Richard C, Lee KF, Campbell M, Hampson L. et al. Lopinavir or zinc finger ejecting compounds as treatment for HPV related lesions? Poster P19.26. 27th International Papillomavirus Conference; Sept 2011; Berlin, Germany.

[15]  Goldstone SE, Kawalek AZ, Huyett JW. Infrared coagulator: a useful tool for treating anal squamous intraepithelial lesions. Dis Colon Rectum 2005; 48: 1042–54.
CrossRef | PubMed |

[16]  Cranston RD, Hirschowitz SL, Cortina G, Moe AA. A retrospective clinical study of the treatment of high grade anal dysplasia by infrared coagulation in a population of HIV positive men who have sex with men. Int J STD AIDS 2008; 19: 118–20.
CrossRef | CAS | PubMed |

[17]  Stier EA, Goldstone SE, Berry JM, Panther LA, Jay N, Krown SE, et al Infrared coagulator treatment of high grade anal dysplasia in HIV infected individuals. J Acquir Immune Defic Syndr 2008; 47: 56–61.
CrossRef | PubMed |

[18]  Goldstone SE, Hundert JS, Huyett JW. Infrared coagulator ablation of high grade anal squamous intraepithelial lesions in HIV negative males who have sex with males. Dis Colon Rectum 2007; 50: 565–75.
CrossRef | PubMed |

[19]  Chang GJ, Berry JM, Jay N, Palefsky JM, Welton ML. Surgical treatment of high grade anal squamous intraepithelial lesions: a prospective study. Dis Colon Rectum 2002; 45: 453–8.
CrossRef | PubMed |

[20]  Pineda CE, Berry JM, Jay N, Palefsky JM, Welton ML. High resolution anoscopy targeted surgical destruction of anal high grade squamous intraepithelial lesions: a ten year experience. Dis Colon Rectum 2008; 51: 829–37.
CrossRef | PubMed |

[21]  Aynaud O, Buffet M, Roman P, Plantier F, Dupin N. Study of persistence and recurrence rates in 106 patients with condyloma and intraepithelial neoplasia after CO2 laser treatment. Eur J Dermatol 2008; 18: 153–8.
| PubMed |

[22]  Nathan M, Hickey N, Mayuranathan L, Vowler SL, Singh N. Treatment of anal human papillomavirus associated disease: a long term outcome study. Int J STD AIDS 2008; 19: 445–9.
CrossRef | CAS | PubMed |

[23]  Salit I, Janet J, William A, Christina M. Anal dysplasia (the TRACE study): comparative effectiveness of ablative therapies. Abstract PS22–15. Proceedings of the 24th International Papillomavirus Conference; November 2007; Beijing.

[24]  Richel O, de Vries H, van Noesel C, Dijkgraaf M, Prins J. Treatment of anal intraepithelial neoplasia in HIV positive MSM: a triple arm randomised clinical trial of imiquimod, topical 5-fluorouracil and electrocautery. Abstract R1002, paper 135LB. 19th Conference on Retroviruses and Opportunistic Infections; March 2012; Seattle.

[25]  Gilson RJ, Shupack JL, Friedman-Kien AE, Conant MA, Weber JN, Nayagam AT, et al A randomised, controlled, safety study using imiquimod for the topical treatment of anogenital warts in HIV infected patients. AIDS 1999; 13: 2397–404.
CrossRef | CAS | PubMed |


   
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