Recurrence of anal high-grade squamous intraepithelial neoplasia post-treatment in HIV-positive women
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BACKGROUND: The incidence of anal cancer in HIV-positive (HIV+) women has increased in the past 3 decades. Anal cancer prevention strategies include the detection and treatment of high-grade squamous intraepithelial lesions (HSIL) of the anus (anal precancer) in order to prevent progression to anal cancer. Studies have evaluated the effectiveness of anal HSIL treatment in HIV+ Men who have Sex with Men (MSM); little is known about the effectiveness of treatment in HIV+ women. OBJECTIVE: To determine the recurrence rate of anal HSIL in HIV+ women after ablative or topical treatment. METHODS: A retrospective chart review was performed on all HIV+ women seen at Boston Medical Center (BMC) between 2004 and 2017 who received treatment for anal HSIL and had at least one follow up visit with high-resolution anoscopy (HRA). The time to recurrence was measured as the time between the first treatment procedure to the date of biopsy-proven HSIL. RESULTS: 84 HIV+ women were diagnosed with anal HSIL. 48 (57%) had treatment of anal HSIL and at least one follow up anal evaluation and were included in the study. The median age of the study cohort was 53 years. The median follow-up time was 3.79 years, with a range of 0.44 to 13.39 years. 8 participants (16.67%) received hyfrecation in clinic, 26 (54.17%) received ablation in the OR, 9 (18.75% received IRC, 2 (4.16%) received imiquimod, and 2 (4.16%) received 5-FU. HSIL recurrence occurred among 29 (60.4%) women. Mean time to recurrence of 25.4 months (95% CI: 15.4-35.4). The probability of anal HSIL recurrence was 26% after 12 months, 46% after 24 months, and 60% after 60 months (5 years). One (2%) study participant developed anal SCC. CONCLUSIONS: Recurrence rates of anal HSIL post-treatment are high in HIV+ women. This group would benefit from close surveillance and long-term follow up.