450. Treatment of High Grade Anal Lesions in High Risk Patients: Outcome at an Urban Community Health Center
Session: Poster Abstract Session: HIV Challenges and Complications
Friday, October 21, 2011
Room: Poster Hall B1
Background: Human Papillomavirus (HPV) causes anal cancer. Those at increased risk of developing anal dysplasia, the putative precursor to anal cancer, include Human Immunodeficiency Virus (HIV)-infected patients and men who have sex with men (MSM).   Anal cancer continues to increase among HIV-infected patients despite the advent of highly active antiretroviral therapy (HAART.) 

Objectives: To describe the outcome of treating biopsy-proven high grade anal dysplasia in HIV-infected and non-HIV-infected men who have sex with men (MSM) receiving primary care in a busy urban community setting.

Methods:  A retrospective review of computerized medical charts of patients with biopsy-proven high grade anal dysplasia between 1996 and 2010 was performed.  Only those with incident high grade lesions and documented follow-up internal exams were included.  A logistic regression model included the following covariates: number of epithelial surface quadrants involved (1 vs. 2,3,or 4), age (<30 vs. age ≥30) and HIV status.  The number of affected quadrants described the disease burden.

Results:  214 incident cases of high grade anal lesions were identified. 154 patients had treatment and met inclusion criteria; 87 (56%) were HIV-infected.  Mean duration of HIV diagnosis was 11.7 years and median CD4 count 514/mm3 with a range of 21 to 1308 at the time of diagnosis.  Treatments included either office-based ablation with a high frequency desiccator or intraoperative carbon dioxide laser destruction.  Eighty patients (51%) were initially treated with ablation, 45(56%) returned for follow-up at least once between 3 and 8 months.  Among those, 23 (51%) were free of high grade lesion, 18 (48%) had high grade disease; and 4 (9%) had unknown disease grading.  Having only one quadrant involved at the time of treatment was significantly associated with a lower probability of high grade disease at follow-up (p-value 0.02.)

Conclusion:  Fifty one percent of patients were free of high grade disease within 3 to 8 months from an office-based procedure. Those with only one quadrant affected were more likely to be free of high grade disease.  Further research is needed to evaluate the long term outcome of treating high grade disease in those at highest risk of developing anal cancer.


Subject Category: H. HIV/AIDS and other retroviruses

Sabrina Assoumou, MD, Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, Lori Panther, MD, MPH, Beth Israel Deaconess Medical Center, Boston, MA, Yang Feng, Department of Biostatistics& Computational Biology, Dana Farber Cancer Institute, Boston, MA, Rebecca Gelman, Ph.D., Department of Biostatistics, Harvard School Of Public Health, Boston, MA, Dana Fugelso, MD, MPH, Beth Israel Deaconess Medical Center, Brookline, MA and Kenneth Mayer, MD, Internal Medicine, Brown University School of Medicine, Providence, RI

Disclosures:

S. Assoumou, None

L. Panther, None

Y. Feng, None

R. Gelman, None

D. Fugelso, None

K. Mayer, None

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