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PURPOSE-The incidence of Anal Intraepithelial Neoplasia (AIN) has risen in HIV patients, and places those patients at risk for the development of anal cancer. The gold standard for surveillance and therapy is unclear. The aim of this study was to determine whether physical examination with anoscopic surveillance in HIV patients diagnosed with AIN is effective at preventing progression to anal cancer
METHOD-A retrospective review of HIV positive patients with AIN, treated with excision and fulguration, was conducted between 2006 through 2012 at our institution. Only patients with at least one year follow up from index evaluation, documented physical examination and anoscopy findings, and pathology were included for analysis.
RESULTS- Thirty six patients met inclusion criteria. The mean age was 41.2 yrs and mean follow up was 30.2 months (12-65months). 15 patients (41.6%)had AIN I, 10 (27.7%) had AIN II and 11(30.5%) had AIN III. 26 patients (72.2%) had repeat procedures. Four patients (11.1%) progressed from low grade to high-grade intraepithelial neoplasia (AIN III). One patient (2.7%) with AIN III developed invasive carcinoma while under surveillance, and was successfully treated with chemoradiation. Complications were seen in two patients (5.5%).
CONCLUSION- Physical examination with routine anoscopy is a simple, safe and effective method for AIN surveillance. The progression rates to anal cancer in this cohort (2.7%) were compared with those published in high-resolution anoscopy surveillance programs (<2%). This is a simple approach that does not require specialized equipment. Randomized trials with longer follow up are required before a standard can be set.