Stier Elizabeth A, Goldstone Stephen E, Berry J Michael, Panther Lori A, Jay Naomi, Krown Susan E, Lee Jeannette, Palefsky Joel M
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J Acquir Immune Defic Syndr. 2008 Jan 1;47(1):56-61. doi: 10.1097/QAI.0b013e3181582d93.
To evaluate prospectively the safety of the infrared coagulator (IRC) as a treatment for anal high-grade squamous intraepithelial lesions (HSILs) in HIV-infected individuals and to seek preliminary evidence for efficacy.
HIV-infected patients with </=3 biopsy-proven internal anal HSILs received office-based treatment with the IRC at participating AIDS Malignancy Consortium sites. Treatments were performed during high-resolution anoscopy (HRA) under local anesthesia. Patients were reevaluated at 3 months, and persistent lesions could be retreated. Patients were evaluated every 3 months for a year with anal cytology and HRA with biopsy. Human papillomavirus (HPV) DNA was measured at baseline and at follow-up using MY09/MY11 L1 polymerase chain reaction.
A total of 44 HSILs were treated from 16 men and 2 women. HPV 16 was the most common HPV type identified. There was no consistent change in HPV type or viral load in patients before and after treatment with the IRC. No procedure-related severe adverse events were reported. Twelve patients reported mild or moderate anal/rectal pain or bleeding.
The IRC is a well-tolerated method of treating discrete anal canal HSILs in HIV-infected patients. A larger study to characterize its efficacy better in the management of HSILs in HIV-infected individuals is warranted.
前瞻性评估红外凝固器（IRC）治疗HIV感染者肛管高级别鳞状上皮内病变（HSILs）的安全性，并寻找疗效的初步证据。
在参与研究的艾滋病恶性肿瘤联盟站点，对活检证实为肛管HSILs且数量≤3个的HIV感染患者，在门诊使用IRC进行治疗。治疗在局部麻醉下的高分辨率肛门镜检查（HRA）期间进行。患者在3个月时接受重新评估，持续性病变可再次治疗。在一年时间里，每3个月对患者进行一次肛门细胞学检查和HRA及活检评估。使用MY09/MY11 L1聚合酶链反应在基线和随访时检测人乳头瘤病毒（HPV）DNA。
共治疗了16名男性和2名女性的44个HSILs。HPV 16是最常见的HPV类型。接受IRC治疗前后，患者的HPV类型或病毒载量没有一致的变化。未报告与手术相关的严重不良事件。12名患者报告有轻度或中度的肛门/直肠疼痛或出血。
IRC是治疗HIV感染患者肛管离散性HSILs的一种耐受性良好的方法。有必要进行一项更大规模的研究，以更好地明确其在HIV感染个体HSILs管理中的疗效。
