红外凝固治疗 HIV 感染男性和女性 2 级和 3 级肛门上皮内瘤变的长期疗效。
Long-term effectiveness of infrared coagulation for the treatment of anal intraepithelial neoplasia grades 2 and 3 in HIV-infected men and women.
机构信息
aLluita Contra La SIDA Foundation bHIV Clinical Unit, Department of Medicine cDepartment of Surgery dRetrovirology Laboratory IrsiCaixa Foundation; University Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Catalonia eLabco.GeneralLab, Barcelona fDepartment of Sanitat i Anatomia Animal, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain. *Guillem Sirera and Sebastián Videla contributed equally to the writing of this article.
出版信息
AIDS. 2013 Mar 27;27(6):951-959. doi: 10.1097/QAD.0b013e32835e06c1.
AIMS
To assess the effectiveness and safety of infrared coagulation (IRC) for the ablation of anal intraepithelial neoplasia (AIN) and to provide data on the prevalence of AIN in HIV-infected patients.
PATIENTS AND METHODS
We performed a single-center, retrospective cohort study based on data collected from a prospectively compiled database of outpatients attended in the Clinical-Proctology-HIV-Unit (first visit). The effectiveness (normal anal cytology after 12 months of IRC) and safety of IRC were estimated.
RESULTS
Between January 2005 and December 2011, a total of 69 (5%) patients with biopsy-proven AIN-2 or AIN-3 from among 1518 patients (1310 men; 208 women) were treated with IRC. The prevalence of cytological abnormalities was 49.5% [751/1518; (atypical squamous cells of unknown significance, 14%; low-grade squamous intraepithelial lesions, 27.5%; high-grade squamous intraepithelial lesions, 8%)]. High-resolution anoscopy revealed intra-anal condylomata in 31% of patients (236/751), nonvisualized lesions in 30% (227/751), and visualized lesions (from which biopsy specimens were taken) in 38% (288/751). The histological diagnosis was: AIN-1, 52% (151/288); AIN-2, 15% (44/288); AIN-3, 9% (25/288); normal, 19% (56/288); and nonevaluable, 4% (12/288). IRC was applied in-office in 66 patients (three refused to undergo treatment). At 12 months, all patients (n = 56) had a normal anal cytology result. Seven (13%) patients had biopsy-proven recurrence [mean (range) time-to-recurrence, 30 (18-43) months]. High-risk-human papilloma virus (HPV) infection was detected in all anal lesions (HPV-16 was the most common genotype). Agreement between cytological and histological results was poor.
CONCLUSION
A high prevalence of AIN was found in both HIV-infected men and HIV-infected women. Although randomized clinical trials are lacking, IRC ablation of AIN-2 and AIN-3 lesions without concomitant condylomata could help prevent anal squamous cell carcinoma.
目的
评估红外凝结（IRC）治疗肛门上皮内瘤变（AIN）的有效性和安全性，并提供 HIV 感染患者中 AIN 患病率的数据。
患者和方法
我们基于在临床直肠病学 HIV 科（首次就诊）的前瞻性数据库中收集的数据进行了单中心回顾性队列研究。估计了 IRC 的有效性（IRC 治疗 12 个月后肛门细胞学正常）和安全性。
结果
2005 年 1 月至 2011 年 12 月，在 1518 例患者（1310 例男性；208 例女性）中，共有 69 例（5%）经活检证实患有 AIN-2 或 AIN-3，接受 IRC 治疗。细胞学异常的患病率为 49.5%[751/1518；（意义不明的非典型鳞状细胞，14%；低级别鳞状上皮内病变，27.5%；高级别鳞状上皮内病变，8%）]。高分辨率肛门镜检查显示 31%的患者（236/751）存在肛门内湿疣，30%（227/751）未发现病变，38%（288/751）发现可进行活检的病变。组织学诊断为：AIN-1，52%（151/288）；AIN-2，15%（44/288）；AIN-3，9%（25/288）；正常，19%（56/288）；无法评估，4%（12/288）。66 例患者（3 例拒绝治疗）在诊室接受 IRC 治疗。12 个月时，所有患者（n=56）肛门细胞学检查结果正常。7 例（13%）患者活检证实复发[复发平均（范围）时间，30（18-43）个月]。所有肛门病变均检测到高危型人乳头瘤病毒（HPV）感染（HPV-16 是最常见的基因型）。细胞学和组织学结果之间的一致性较差。
结论
在 HIV 感染的男性和 HIV 感染的女性中均发现 AIN 患病率较高。虽然缺乏随机临床试验，但 IRC 消融 AIN-2 和 AIN-3 病变而不伴湿疣有助于预防肛门鳞状细胞癌。
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