Date Published: August 1, 2018
Publisher: Public Library of Science
Author(s): Sandra Vela, Sebastian Videla, Arelly Ornelas, Boris Revollo, Bonaventura Clotet, Guillem Sirera, Marta Piñol, Francesc García-Cuyás, Magdalena Grce.
There is limited information on the effectiveness of available treatments for anal condyloma acuminata in HIV-1-infected men.
To provide data on the effectiveness of electrosurgical excision, infrared coagulation and pharmacological (imiquimod) treatments for anal condyloma acuminata (peri-anal and/or intra-anal) in HIV-1-infected men based on authors’ practice.
Single-center, retrospective descriptive analysis of HIV-1-infected men, 18 years or older treated for anal condyloma acuminata. Standard treatments were offered: electrosurgery excision, infrared coagulation and topical imiquimod. Effectiveness was evaluated by the recurrence rate at 1 year after treatment. Recurrence was defined as any anal condyloma acuminata diagnosed after 3 months of condyloma-free survival post-treatment. Anal cytology and human-papillomavirus-infection (HPV) was assessed.
Between January 2005 and May 2009, 101 men were treated for anal condyloma acuminata: 65 (64%) with electrosurgery, 27 (27%) with infrared coagulation and 9 (9%) with imiquimod. At 1 year after treatment, the cumulative recurrence rate was 8% (4/65, 95%CI: 2–15%) with electrosurgery excision, 11% (3/27, 95%CI: 4–28%) with infrared coagulation and 11% (1/9, 95%CI: 2–44%) with imiquimod treatment. No predictive factors were associated with recurrence.
Recurrence of anal condyloma after any treatment was common. Abnormal anal cytology and high-risk HPV-infection were highly prevalent in this population, therefore at high-risk of anal cancer, and warrants careful follow-up.
Anal condyloma acuminata (CA) are frequently associated with human papillomavirus (HPV) types 6 and 11 [1,2]. CA may be located peri-anally or intra-anally and patients commonly present for medical treatment due to feeling ‘bumps’ when washing or more infrequently after findings on routine medical examinations such as colonoscopy, or more rarely with symptoms such as itch, wetness or pain. Global incidence of anogenital warts ranges from 160 to 289 cases per 100 000 person-years [3,4]. The histology of anogenital warts typically shows benign characteristics, although intraepithelial or invasive squamous cell carcinomas can coexist .
The aim of this study was not to compare the effectiveness of different treatments for anal condyloma in HIV-1-infected men, as treatment depended on factors such as the number of condyloma, size of affected area, location and characteristics of the patients. Nevertheless, to our knowledge, this is the first time that the effectiveness of different treatments (electrosurgery, infrared coagulation and imiquimod) for the treatment of anal CA in HIV-1-infected men (MSW and MSM) is evaluated during a long period of time. In spite of an excellent observed effectiveness at 3 months (no recurrence) and at one year after treatment (on 10% of recurrence), a high rate of CA recurrence was found when the follow-up was up to 10 years treatment (on 50% of recurrence). These recurrence rates were unrelated to treatment type. However, our descriptive results suggest that HIV-1-infected men treated for anal CA are a population with a high probability of suffering a recurrence, independent of the treatment used.