Effectiveness of physically ablative and pharmacological treatments for anal condyloma in HIV-infected men

PLoS One. 2018 Aug 1;13(8):e0199033. doi: 10.1371/journal.pone.0199033. eCollection 2018.

Abstract

Background: There is limited information on the effectiveness of available treatments for anal condyloma acuminata in HIV-1-infected men.

Aim: 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.

Methods: 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.

Results: 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. Anal HPV-6 or HPV-11 was detectable in 98 (97%) patients and all had high-risk HPV genotypes, and 89 (88%) patients had abnormal anal canal cytology. Limitations: this was a retrospective descriptive analysis; limited to a single center; it cannot know if the recurrence is related to new infection.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adjuvants, Immunologic / therapeutic use*
  • Adolescent
  • Adult
  • Anti-Retroviral Agents / therapeutic use
  • Anus Diseases / complications
  • Anus Diseases / surgery
  • Anus Diseases / therapy*
  • Condylomata Acuminata / complications
  • Condylomata Acuminata / surgery
  • Condylomata Acuminata / therapy*
  • Electrosurgery*
  • Genotype
  • HIV Infections / complications
  • HIV Infections / diagnosis*
  • HIV Infections / drug therapy
  • Homosexuality, Male
  • Human papillomavirus 11 / genetics
  • Human papillomavirus 11 / isolation & purification
  • Human papillomavirus 6 / genetics
  • Human papillomavirus 6 / isolation & purification
  • Humans
  • Imiquimod / therapeutic use
  • Infrared Rays
  • Male
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult

Substances

  • Adjuvants, Immunologic
  • Anti-Retroviral Agents
  • Imiquimod

Associated data

  • Dryad/10.5061/dryad.fn74266

Grants and funding

This study was funded by grants from the Lluita Contra La SIDA Foundation and FIS P15/00492. The study’s funder was not involved in study design, neither data interpretation, nor revision of the final report. The corresponding author had full access to all study data and had final responsibility for the decision to submit the paper for publication. B.C. has received honoraria for speaking and participating in advisory boards from Abbott, Bristol-Myers Squibb, Boehringer-Ingelheim, Gilead Sciences, GlaxoSmithKline, Pfizer, Merck, and Janssen-Tibotec. These funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.