Cryotherapy for Intra- and Perianal High-Grade Squamous Intraepithelial Lesions in HIV-Positive Men who have Sex with Men.

Autor: Siegenbeek van Heukelom ML; Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Room F4-106, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.l.vanheukelom@amc.uva.nl.; Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands. m.l.vanheukelom@amc.uva.nl.; Department of Dermatology, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands. m.l.vanheukelom@amc.uva.nl., Gosens KCM; Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands.; Department of Dermatology, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands., Prins JM; Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Room F4-106, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.; Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands., de Vries HJC; Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands.; Department of Dermatology, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands.; STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), 1018 WT, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: American journal of clinical dermatology [Am J Clin Dermatol] 2018 Feb; Vol. 19 (1), pp. 127-132.
DOI: 10.1007/s40257-017-0311-z
Abstrakt: Background: Available treatment options for anal high-grade squamous intraepithelial lesions (HSIL) in HIV-positive men who have sex with men (MSM) are limited by low response rates and frequent recurrences. Cryotherapy is an established therapeutic option for several pre-malignant skin disorders.
Methods: This retrospective, non-randomized study included HIV-positive MSM who received intra- and/or perianal HSIL cryotherapy treatment between 30 December 2008 and 23 April 2015. Cryotherapy was applied in sessions 4-6 weeks apart for a maximum of five sessions. Patients received a follow-up high-resolution anoscopy (HRA) to assess treatment response. Complete and partial treatment responders were followed-up after 6 months and then every 6-12 months to investigate recurrent HSILs.
Results: Of 64 patients [median age 48 years; interquartile range (IQR) 42-56] included in the study, six were lost to follow-up. In total, 35 (60%) of 58 patients responded to treatment. Of 64 patients, 31 (48%) reported one or more side effects, of which anal pain or tenderness and mild blood loss were reported most frequently. A total of 19 patients who responded to cryotherapy were adequately followed-up for over 18 months, of whom 13 (68%) had recurrent HSILs.
Conclusion: Cryotherapy is capable of clearing HSIL in HIV-positive MSM, and treatment success rates are comparable with those reported for current treatment modalities. The treatment is well tolerated, and side effects are relatively mild. Future studies should therefore compare the efficacy and tolerability of cryotherapy with those of current treatment modalities in randomized controlled trials.
Databáze: MEDLINE
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