{"id":16431,"date":"2012-06-01T13:35:27","date_gmt":"2012-06-01T13:35:27","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=16431"},"modified":"2013-08-12T12:07:12","modified_gmt":"2013-08-12T12:07:12","slug":"promising-outcomes-from-laser-ablative-treatment-of-ain23-to-prevent-anal-cancer","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/16431","title":{"rendered":"Promising outcomes from laser ablative treatment of AIN2\/3 to prevent anal cancer"},"content":{"rendered":"

Simon Collins, HIV i-Base<\/strong><\/p>\n

The incidence of anal cancer is higher in HIV positive compared to negative populations with lower rates of clearance (87% vs 38% at 5 years) and progression rates from high-grade anal intraepithelial neoplasia (AIN 2\/3) in observational studies range from approximately 8-14% over 5 years.<\/strong><\/p>\n

Thornhill and colleagues reported on retrospective results (median 69 months follow-up, range 36-180 months) from treating 91 patients (35 AIN 3; 56 AIN 2) with laser ablative treatment at Homerton Hospital in east London. [1]<\/p>\n

Most patients were male (82\/91) and MSM (80\/82). Mean age was 36.9 (range 20-68). Of the 56 HIV positive patients, 66% (n=37) had a CD4 nadir of <200 cell\/mm3. 45% (25\/56) had been HIV positive for 15 years or more.<\/p>\n

None of the patients in this cohort developed anal cancer suggesting that treatment may have prevented lesion progression in some patients.<\/p>\n

The single case of anal cancer in this cohort, not included in this analysis follow-up was less than 3 years was a 49 year-old man (HIV positive for 21 years) with a CD4 nadir of 8. He had advanced 3 quadrant AIN 3 disease that presented late.<\/p>\n

A second poster reported prospective first year results from a new ano-rectal outpatient clinic for HIV positive patients at the Royal Free Hospital. [2]<\/p>\n

This is a monthly clinic for patients with a history of anal warts or previously diagnosed AIN. Symptomatic patients are screened by anoscopy +\/- (surgical) evaluation under anaesthesia (EUA) where indicated. Patients were referred by their clinic doctor or self referred through promotion throughout the clinic.<\/p>\n

Data was compiled from 73 patients seen over 12 months. Median (IQR) demographics included: age 45 years (IQR 41-50) years, 91% were MSM (67\/73), 85% Caucasian (61\/73). 95% (69\/73) were on ART, 82% (60\/73) with undetectable viral load. CD4 at presentation and CD4 nadir were 511 (362-741) and 152 (26-288) cells\/mm3 respectively. Median time since HIV diagnosis was 15 years (10-20), with 11(6-13) years on HARRT. 75% (55\/73) were smokers.<\/p>\n

Anoscopy +\/- EUA for screening was undertaken for 40% (30\/73). Of these 27% (8\/30) were diagnosed with AIN: AIN-1 (3), AIN-2 (2), and AIN-3 (3). 3\/8 had prior diagnosis of AIN, the remainder were all newly diagnosed. 3\/30 (10%) were diagnosed with ASCC and were managed by the surgeons and oncologists.<\/p>\n

The clinic plans to expand the service to include a screening clinic specifically targeting all HIV positive, MSM who are >40 years, or have low CD4 nadir, or HIV infection > 10 years to undergo routine screening for AIN with Human Papilloma Virus (HPV) cytology, HPV typing and baseline anoscopy.<\/p>\n

comment<\/h3>\n

Greater awareness of AIN in HIV positive gay men, easier access to screening and the necessary support to diagnose complications is important.<\/strong><\/p>\n

The variable progression rates, lack of natural history data and recent availablility of effective treatments all highlight the urgent need for randomised data for the benefit of screening.<\/strong><\/p>\n

References:<\/p>\n

    \n
  1. Thornhill J et al. Treatment of anal intraepithelial neoplasia and prevention of anal carcinoma. 18th BHIVA Conference, 18-20 April 2012, Birmingham. Poster abstract 64. Download poster<\/a>.<\/li>\n
  2. Grover D et al. Anal intraepithelial neoplasia: single centre experience. 18th BHIVA Conference, 18-20 April 2012, Birmingham. Poster abstract 68. Download poster<\/a>.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base The incidence of anal cancer is higher in HIV positive compared to negative populations with lower rates of clearance (87% vs 38% at 5 years) and progression rates from high-grade anal intraepithelial neoplasia (AIN 2\/3) in …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,31,18],"tags":[11],"class_list":["post-16431","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-opportunistic-infections-coinfections-and-complications","category-cancer-and-hiv","tag-bhiva-18th-2012"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/16431","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=16431"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/16431\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=16431"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=16431"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=16431"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}