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Cited by 112Colorectal and Anal CarcinomasCervical Cancer and HPV ResearchHIV/AIDS Research and Interventions

Progression to and spontaneous regression of high-grade anal squamous intraepithelial lesions in HIV-infected and uninfected men.

Tong, Winnie W.Y., Jin, Fengyi, McHugh, Leo C., Maher, Tara, Sinclair, Brett, Grulich, Andrew E., Hillman, Richard J., Carr, Andrew·2013·AIDS
DOI 10.1097/qad.0b013e3283633111
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Abstract

OBJECTIVE: To quantify incidence of, and risk factors for, progression to and spontaneous regression of high-grade anal squamous intraepithelial lesions (ASILs). DESIGN: Retrospective review of patients at St Vincent's Hospital Anal Cancer Screening Clinic during a period when high-grade ASILs were not routinely treated (2004-2011). METHODS: All patients who had an anal Papanicolaou smear or high-resolution anoscopy were included, except for patients with previous anal cancer. High-grade anal intraepithelial neoplasia (HGAIN) was defined as a composite of histologically confirmed grade 2 or 3 anal intraepithelial neoplasia (AIN2/3) and/or high-grade squamous intraepithelial lesion on anal cytology. Analyses were repeated restricting to histologically confirmed AIN3. RESULTS: There were 574 patients: median age 45 years (interquartile range, IQR 36-51), 99.3% male and 73.0% HIV-infected [median HIV duration was 13.8 years (IQR 6.4-19.8), median CD4+ T-lymphocyte count was 500 cells/μl (IQR 357-662), 83.5% had undetectable plasma HIV viral load]. Median follow-up was 1.1 years (IQR 0.26-2.76). Progression rate to HGAIN was 7.4/100 person-years (95% confidence interval, CI 4.73-11.63). No risk factor for progression to HGAIN was identified; progression to AIN3 was more likely with increasing age (Ptrend = 0.004) and in those who were HIV-infected [hazard ratio 2.8 (95% CI 1.18-6.68) versus HIV-uninfected; P = 0.019], particularly in those whose nadir CD4+ T-lymphocyte count was less than 200 cells/μl (Ptrend = 0.003). In 101 patients with HGAIN, 24 (23.8%) patients had spontaneous regression [rate 23.5/100 person-years (95% CI 15.73-35.02)], mostly to AIN1. Regression was less likely in older patients (Ptrend = 0.048). Two patients with HGAIN developed anal cancer. CONCLUSION: High-grade ASILs frequently spontaneously regress. Longer-term, prospective studies are required to determine whether these regressions are sustained.

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  • Evidence exists that HSIL might spontaneously regress without treatment.

    “In addition, evidence exists that HSIL might spontaneously regress without treatment (1294,1295).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [1295]

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Authors
Tong, W. W. Y., Jin, F., McHugh, L. C., Maher, T., Sinclair, B., Grulich, A. E., Hillman, R. J., & Carr, A.
Affiliations
  • The University of Sydney (AU)
  • UNSW Sydney (AU)
  • St Vincent's Hospital Melbourne (AU)
Corresponding author
  • Hillman, Richard J.
  • Carr, Andrew
ORCID
Venue
AIDS
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2013-09-10
Volume
27
Issue
14
Pages
2233-2243
ISSN
0269-9370 (ISSN-L)
DOI
10.1097/qad.0b013e3283633111
OpenAlex
W2013874226
Cited by
112
References
26
Citations by year
2026: 2 · 2025: 10 · 2024: 3 · 2023: 7 · 2022: 7 · 2021: 10 · 2020: 10 · 2019: 15 · 2018: 11 · 2017: 12 · 2016: 4 · 2015: 9 · 2014: 9 · 2013: 2
FWCI
7.88
Type
journal article
Language
en
Open access
closed
Locations
  • AIDS (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Colorectal and Anal Carcinomas
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords
anal squamous intraepithelial lesions, high-grade anal intraepithelial neoplasia, HIV infection, anal cancer screening, disease progression, spontaneous regression, high-resolution anoscopy, CD4 count, risk factors, men, anal cancer prevention
MeSH terms
Adult, Anus Neoplasms, Carcinoma in Situ, Cytological Techniques, Histocytochemistry, Humans, Male, Remission, Spontaneous, Retrospective Studies, Cohort Studies, HIV Infections, Incidence, Young Adult, Papanicolaou Test

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