International Journal of STD & AIDS > Volume 19, Number 7 > Pp. 445-449

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Original research articles

Treatment of anal human papillomavirus-associated disease: a long term outcome study

M Nathan FRCP ^*, N Hickey SRN ^*, L Mayuranathan BSc ^* , S L Vowler MSc  and N Singh FRCPath 

^* Department of Sexual Health, Homerton University Hospital, London E9 6SR; Centre for Applied Medical Statistics, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR; Department of Pathology, Barts and the London NHS Trust, London E1 1BB, UK

Correspondence to: Dr Mayura Nathan Email: mayura.nathan{at}homerton.nhs.uk

Treatment for human papillomavirus (HPV)-associated anal canal disease has been unsatisfactory. The objective of our study was to determine the treatment outcome in our cohort with anal HPV disease. Overall, 181 patients were evaluated over a median period of 19.1 months (range = 2.8–125.5). Eighty-eight patients (48.6%) with high-grade anal intraepithelial neoplasia (AIN) and 82 patients (45.3%) with low-grade AIN underwent treatment. One hundred and forty-one patients (77.9%) received laser ablative treatment as an outpatient procedure. The treatment yielded cure, defined as a disease-free state at 12 months after treatment, in 63.0% (114/181). Median time to cure for the cohort was 31.5 months (95% confidence interval: 23.0–40.0). Treatment outcome showed no evidence of being affected by age, sexual preference, history of smoking or presence of high-grade disease. Median time to cure was significantly affected by a positive HIV status (P = 0.02) and the extent (volume) of the disease (P = 0.01). Contrary to the current view that treatment of HPV-related anal disease is difficult, unrewarding due to recurrences and may lead to substantial morbidity, we demonstrate that effective treatment is possible for both low- and high-grade AIN. These findings should help with the general desire to introduce screening for AIN for at-risk groups.

Key Words: anal intraepithelial neoplasia • laser treatment • anal cancer screening • anal warts

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