Treatment of anal dysplasia in HIV-positive men who have sex with men in a large AIDS reference centre

Abstract

Treatment of anal dysplasia appears to be safe and to offer short-term efficiency. However, its long-term efficiency remains unknown, especially in the HIV-positive population in which spontaneous clearance is lower and rate of recurrence higher.

Imiquimod anal tampons treatment of anal intraepithelial neoplasia

“…2,3 High-risk HPV is strongly associated with the development of high degrees of anal intraepithelial neoplasia (AIN) which, later on, can develop into anal squamous carcinoma. 1,2,4 The growing incidence of anal cancer during last years is particularly important in MSM and HIV-positive patients, 1,[5][6][7] in which the coexistence of multiple serotypes of HPV reduces the probability of eliminating the AIN. 3,5,8,9 The treatments for anal dysplasia have shown limited effectiveness.…”

“…3,5,8,9 The treatments for anal dysplasia have shown limited effectiveness. 4,6,7 Imiquimod (1-[2-methylpropyl]-1H-imidazo-[4,5-c]quinolin-4-amine) has been successfully used for different neoplasia. 3 Our study attempts to evaluate the degree of effectiveness of two formulas of imiquimod anal tampon (6.25 mg and 15 mg by tampon), in monotherapy, in HIV-positive and HIV-negative patients with AIN, from a sexually transmitted diseases (STD) consulting room.…”

“…3,9 In general terms, AIN treatments are effective only in the short and medium term. 4,6,7 Surgery is the most used method in the treatment of high-grade AIN but it implies a high risk of anal stenosis or faecal incontinence. 1,5,6 Nevertheless, some patients prefer topical treatments, to perform them at home.…”

“…4,6,7 Surgery is the most used method in the treatment of high-grade AIN but it implies a high risk of anal stenosis or faecal incontinence. 1,5,6 Nevertheless, some patients prefer topical treatments, to perform them at home. 10 Imiquimod acts as an antiviral and antitumour agent through immunomodulation mechanisms and it is also used in recurrent warts, nodular basal cell carcinoma, Bowen's disease, squamous cell carcinoma or vulvar intraepithelial neoplasia, among others.…”

“…3 When, for example, a Sutton naevus disappears could the residual leucoderma be Wolf and if the leucodermic patch heals, could we then speak of a 'reverse' Wolf phenomenon? 4 Direct or indirect hypersensitivity to herpes simplex virus (HSV) was a mooted mechanism for the Wolf response 5,6 in pseudolymphoma, yet pseudolymphoma has been described after leech therapy 7 , where HSV hypersensitivity is not an issue.…”