Santa Casa de SP Brazil
Title: Screening related factors on Anal Canal lesions in HIV-positive patients
Sylvia Heloisa Arantes Cruz has completed her Ph.D. at the age of 35 years from Santa Casa de Sao Paulo, Brazil. She is an assistant Professor at Santa Casa de Sao Paulo, Brazil and her research is on screening anal cancer in HIV-positive patients.
The incidence of anal dysplasia in men who have sex with men (MSM) HIV-positive patients is increasing. This dysplasia is described as both high grade anal intraepithelial (HAIN) and low grade anal intraepithelial (LAIN). The anal squamous cell carcinoma (ASCC) is more frequent in HIV-positive patients and is related to papillomavirus infections (HPV), low systemic immunity condition and long use of highly active antiretroviral therapy. The anal pap smear protocol and the high resolution anoscopy seem effective in the screening of anal dysplasia and early anal cancer. The aim of this research was to identify some factors that could raise the risk for HAIN and LAIN in HIV-positive patients. We evaluated 134 HIV-positive and HIV-negative patients with preceding anal intercourse at CRT/AIDS Sao Paulo from October 2011 through March 2012. HIV-negative patients and HIV-positive without recent CD4 lymphocytes counts were excluded. All of the patients were submitted to anal pap smear protocol and high resolution anoscopy. The anal lesions were treated with trichloroacetic acid (TCA) 90% and imiquimod 5% for 12 weeks. The patients with reminiscent lesions were operated. The statistical analysis was performed with student's t-test and the significance level was below 5%. 97 patients were evaluated (86 male and 11 female), 31 had warts and 5 had LAIN. One patient was operated after the TCA 90% and imiquimod 5% treatment. In conclusion, HIV-positive patients with anal warts had low CD4 lymphocytes counts and anal dysplasia.