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Argon plasma coagulation treatment of anal high‐grade squamous intraepithelial lesions in men who have sex with men living with HIV : results of a 2‐year prospective pilot study
Author(s) -
Pokomandy A,
Rouleau D,
Lalonde R,
Beauvais C,
Castro C,
Coutlée F
Publication year - 2018
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12544
Subject(s) - medicine , anal cancer , argon plasma coagulation , prospective cohort study , men who have sex with men , adverse effect , anal canal , human immunodeficiency virus (hiv) , gynecology , surgery , immunology , endoscopy , syphilis , rectum
Objectives Men who have sex with men ( MSM ) living with HIV are at high risk for anal high‐grade squamous intraepithelial lesions ( HSIL s) and cancer. The best management of anal HSIL remains unclear. Our objective was to assess whether argon plasma coagulation ( APC ) could be safe, well tolerated and efficient to treat anal HSIL s in MSM living with HIV . Methods A prospective phase II , open‐label, pilot study was conducted to evaluate APC to treat anal HSIL s in 20 HIV ‐positive MSM . Participants were followed for 2 years after their first treatment. Results Twenty men with persistent HSIL s completed the 2‐year study. Their baseline median CD 4 count was 490 cells/μL and 85% had undetectable HIV viral loads. Overall, 65% (13/20) of participants were clear of HSIL s at their 24‐month visit. The initial response rates after the first, second and third APC treatments were 45%, 44% and 67%, respectively, but recurrences were common. The main side effect was pain during and within 1 week after the treatments. There were no long‐term side effects, nor serious adverse events related to the procedure. Cost is a drawback. Conclusions APC can be used to treat anal HSIL s in HIV ‐seropositive MSM , and requires repeated treatment because of a high recurrence rate. As successful treatment of human papillomavirus ( HPV ) infection or eradication of the anal transitional zone remains impossible, HSIL treatment is challenging and requires long‐term follow‐up.