Infrared Coagulation of Anal High-Grade Dysplasia and Lesion Resolution in Persons Living With HIV

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Ablation of anal high-grade dysplasia may reduce invasive cancer incidence. <i>Photo Credit: Ida Wyman/Medical Images</i>
Ablation of anal high-grade dysplasia may reduce invasive cancer incidence. Photo Credit: Ida Wyman/Medical Images

Treating anal high-grade dysplasia with infrared coagulation significantly increases the likelihood of complete clearance in individuals infected with HIV, according to a study recently published in Clinical Infectious Diseases.

This randomized, open-label, multisite clinical trial included 120 individuals living with HIV who were at least 27 years old. The participants were randomized 1:1 to receive treatment via infrared coagulation or active monitoring.

The treatment group achieved a higher rate of complete clearance of anal high-grade dysplasia than the monitoring group (62% vs 30%; 95% CI, 13%-48%; P <.001).

Participants who had only 1 index lesion were 1.96 times more likely to achieve complete clearance than those with 2 to 3 index lesions (95% CI, 1.22-3.10).

Mild to moderate pain and bleeding at the treatment site were the most common adverse events, with no serious adverse events occurring as a result of treatment.

Participants in this study had between 1 and 3 anal high-grade dysplasias confirmed by biopsy and had no previous history of treatment using infrared coagulation. Complete clearance of index high-grade dysplasia at 1 year was the primary endpoint.

The study researchers performed follow-up every 3 months using high-resolution anoscopy, with new or recurrent high-grade dysplasia biopsied in participants within the treatment group. Those in the active monitoring group had biopsies at the 1-year mark.

The study researchers conclude that, "[infrared] coagulation ablation of anal [high-grade dysplasia] results in more clearance of [high-grade dysplasia] compared to observation alone."

Reference

Goldstone SE, Lensing SY, Stier EA, et al. A randomized clinical trial of infrared coagulation ablation versus active monitoring of intra-anal high-grade dysplasia in HIV-infected adults: an AIDS malignancy consortium trial [published online July 27, 2018]. Clin Infect Disord. doi: 10.1093/cid/ciy615

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