Predictors of Resolution and Recurrence of Anal High-Grade Squamous Intraepithelial Lesions in People With HIV.

IF 2.4 4区医学 Q2 OBSTETRICS & GYNECOLOGY Journal of Lower Genital Tract Disease Pub Date : 2024-11-26 DOI:10.1097/LGT.0000000000000857

Joy C Zhang, Maria C Geba, Yvonne Newberry, Laura Quass-Ferdinand, Tania A Thomas, Sook Hoang

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Abstract

Objective: High-resolution anoscopy (HRA) with ablation of high-grade squamous intraepithelial lesions (HSIL) can prevent the development of anal cancer in people with HIV (PWH). We sought to characterize factors associated with successful HSIL resolution or local or metachronous recurrence.

Methods: We conducted a retrospective study of 62 PWH who underwent HRAs from December 1, 2017 to July 1, 2022. Participants were ≥30 years old with ≥2 HRAs and ≥1 HSIL lesions. Poisson and logistic regressions were used to assess factors associated with HSIL resolution and local or metachronous recurrence of HSIL.

Results: Of 62 PWH, 85.5% had resolution of at least 1 HSIL. Undergoing ≥5 HRAs with thermoablation was associated with HSIL resolution (adjusted rate ratio [aRR] = 2.82) (confidence interval [CI] = 1.55-5.15), p < .001). Tobacco use was negatively associated with resolution (aRR = 0.62 (CI = 0.43-0.90), p = .01). Of this cohort, 58.1% had HSIL recurrence. Having more HRAs (adjusted odds ratio [aOR] = 2.77 (CI = 1.27-6.06), p = .01) and female sex (aOR = 9.66 (CI = 1.14-81.85), p = .04) were associated with recurrence. Non-White race was negatively associated with recurrence (aOR = 0.12 (CI = 0.02-0.68), p = .04). Our study was primarily limited by its retrospective nature and small sample size.

Conclusion: Our study supports the utility of HRA/ablation for HSIL treatment with >85% of participants experiencing resolution of at least 1 HSIL. We found that having more HRAs was associated with a higher likelihood of resolution. However, the high rate of recurrence and progression to HSIL highlights the need for continued surveillance after treatment.

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艾滋病病毒感染者肛门高级别鳞状上皮内病变消退和复发的预测因素。

目的：高分辨率肛门镜（HRA）消融高级别鳞状上皮内病变（HSIL）可预防艾滋病病毒感染者（PWH）罹患肛门癌。我们试图找出与成功消融 HSIL 或局部或远期复发相关的因素：我们对 2017 年 12 月 1 日至 2022 年 7 月 1 日期间接受 HRA 的 62 名 PWH 进行了回顾性研究。参与者年龄≥30岁，HRA≥2例，HSIL病变≥1例。采用泊松回归和逻辑回归评估与HSIL消退和HSIL局部或远期复发相关的因素：结果：在62例PWH中，85.5%的患者至少有1个HSIL消退。接受≥5次带有热消融的HRA与HSIL消退有关（调整率比[aRR] = 2.82）（置信区间[CI] = 1.55-5.15），P < .001）。吸烟与HSIL消退呈负相关（aRR = 0.62 (CI = 0.43-0.90), p = .01）。在这组患者中，58.1%的人复发了HSIL。拥有更多 HRA（调整赔率 [aOR] = 2.77 (CI = 1.27-6.06)，p = .01）和女性（aOR = 9.66 (CI = 1.14-81.85)，p = .04）与复发有关。非白人种族与复发呈负相关（aOR = 0.12 (CI = 0.02-0.68), p = .04）。我们的研究主要受限于其回顾性和较小的样本量：我们的研究支持HRA/消融治疗HSIL的有效性，85%以上的参与者至少有1个HSIL得到了治疗。我们发现，HRA次数越多，治愈的可能性越大。然而，HSIL 的复发率和进展率很高，这突出表明治疗后仍需继续监测。

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来源期刊

Journal of Lower Genital Tract Disease OBSTETRICS & GYNECOLOGY-

CiteScore

6.80

自引率

8.10%

发文量

158

审稿时长

6-12 weeks

期刊介绍： The Journal of Lower Genital Tract Disease is the source for the latest science about benign and malignant conditions of the cervix, vagina, vulva, and anus. The Journal publishes peer-reviewed original research original research that addresses prevalence, causes, mechanisms, diagnosis, course, treatment, and prevention of lower genital tract disease. We publish clinical guidelines, position papers, cost-effectiveness analyses, narrative reviews, and systematic reviews, including meta-analyses. We also publish papers about research and reporting methods, opinions about controversial medical issues. Of particular note, we encourage material in any of the above mentioned categories that is related to improving patient care, avoiding medical errors, and comparative effectiveness research. We encourage publication of evidence-based guidelines, diagnostic and therapeutic algorithms, and decision aids. Original research and reviews may be sub-classified according to topic: cervix and HPV, vulva and vagina, perianal and anal, basic science, and education and learning. The scope and readership of the journal extend to several disciplines: gynecology, internal medicine, family practice, dermatology, physical therapy, pathology, sociology, psychology, anthropology, sex therapy, and pharmacology. The Journal of Lower Genital Tract Disease highlights needs for future research, and enhances health care. The Journal of Lower Genital Tract Disease is the official journal of the American Society for Colposcopy and Cervical Pathology, the International Society for the Study of Vulvovaginal Disease, and the International Federation of Cervical Pathology and Colposcopy, and sponsored by the Australian Society for Colposcopy and Cervical Pathology and the Society of Canadian Colposcopists.