Family Medicine Department, McGill University, Montreal, QC, Canada.
Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
HIV Med. 2018 Feb;19(2):81-89. doi: 10.1111/hiv.12544. Epub 2017 Aug 23.
Men who have sex with men (MSM) living with HIV are at high risk for anal high-grade squamous intraepithelial lesions (HSILs) 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 HSILs in MSM living with HIV.
A prospective phase II, open-label, pilot study was conducted to evaluate APC to treat anal HSILs in 20 HIV-positive MSM. Participants were followed for 2 years after their first treatment.
Twenty men with persistent HSILs completed the 2-year study. Their baseline median CD4 count was 490 cells/μL and 85% had undetectable HIV viral loads. Overall, 65% (13/20) of participants were clear of HSILs 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.
APC can be used to treat anal HSILs 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.
男男性行为者（MSM）合并 HIV 感染后，肛门高级别鳞状上皮内病变（HSIL）和癌症的风险较高。肛门 HSIL 的最佳治疗方法仍不明确。本研究旨在评估氩等离子凝固（APC）治疗合并 HIV 感染的 MSM 肛门 HSIL 的安全性、耐受性和有效性。
一项前瞻性、开放标签、试点研究评估了 APC 治疗 20 例合并 HIV 的 MSM 肛门 HSIL 的疗效。患者在首次治疗后随访 2 年。
20 例持续性 HSIL 患者完成了 2 年的研究。他们的基线中位 CD4 计数为 490 个/μL，85%的患者 HIV 病毒载量无法检测到。总体而言，24 个月时，65%（13/20）的患者 HSIL 完全消退。首次、第二次和第三次 APC 治疗后的初始反应率分别为 45%、44%和 67%，但复发较为常见。主要的副作用是治疗过程中和治疗后 1 周内的疼痛。无长期副作用，也无与该操作相关的严重不良事件。费用是一个缺点。
APC 可用于治疗合并 HIV 的 MSM 肛门 HSIL，但由于复发率高，需要重复治疗。由于人乳头瘤病毒（HPV）感染的成功治疗或肛门移行区的根除仍不可能，HSIL 的治疗具有挑战性，需要长期随访。
