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

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

doi:10.1097/LGT.0000000000000857

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

J Low Genit Tract Dis. 2024 Nov 26. doi: 10.1097/LGT.0000000000000857. Online ahead of print.

Authors

Joy C Zhang¹, Maria C Geba², Yvonne Newberry², Laura Quass-Ferdinand², Tania A Thomas², Sook Hoang³

Affiliations

¹ University of Virginia School of Medicine, Charlottesville, VA.
² University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, VA.
³ University of Virginia, Department of Surgery, Charlottesville, VA.

PMID: 39588849
DOI: 10.1097/LGT.0000000000000857

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.