Author(s): Kreuter A, Potthoff A, Brockmeyer NH, Gambichler T, Stcker M, , Kreuter A, Potthoff A, Brockmeyer NH, Gambichler T, Stcker M,
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Abstract Anal intraepithelial neoplasia (AIN), a human papillomavirus (HPV)-associated precursor lesion of anal carcinoma, is highly prevalent in HIV-infected men having sex with men (MSM). This prospective follow-up study evaluated the long-term results of imiquimod treatment of AIN in 19 HIV-infected MSM. Standardized follow-up examinations included high-resolution anoscopy, anal cytology/histology, HPV typing, and DNA load determination for HPV types 16, 18, 31, and 33. Mean follow-up time was 30.3 months. A total of 74\% (14/19) of the patients remained free of AIN at the previously treated site. Five patients (26\%) had recurrent high-grade AIN after a mean time of 24.6 months. At the end of follow-up, the numbers of HPV types as well as high-risk HPV-DNA loads were significantly lower than before therapy. During follow-up, 58\% of all patients (11/19) developed new anal cytological abnormalities in previously normal, untreated anal regions. 55\% of these new AIN lesions were high-grade lesions and most of them were located intra-anally and associated with high-risk HPV types not detectable before therapy. These results demonstrate that imiquimod leads to a high rate of long-term clearance of AIN in HIV-positive men together with a prolonged decrease of high-risk HPV-DNA load. However, new AIN lesions associated with previously undetected HPV types frequently occur in untreated areas.
This article was published in J Invest Dermatol
and referenced in Journal of AIDS & Clinical Research