Effectiveness of trichloroacetic acid versus electrocautery for the treatment of anal high-grade squamous intraepithelial lesions in persons with HIV

Abstract

Purpose

This study aimed to compare trichloroacetic acid (TCA) versus electrocautery (ECA) for the treatment of anal high-grade squamous intraepithelial lesions (HSIL).

Methods

This is an observational, single-center study. All subjects with HIV who had anal HSIL treated with TCA or ECA from 2010 to 2022 were included. Effectiveness was evaluated by on-treatment analysis, defining response as the resolution of HSIL and recurrence as a new diagnosis of HSILs during follow-up. A propensity score analysis was used to adjust for confounding factors.

Results

In total, 227 and 260 HSIL episodes were treated with ECA and TCA, respectively. Response was observed in 61.7% (95% CI: 55.3–68) of cases treated with ECA and in 73.1% (95% CI: 67.8–78.5) with TCA (p = .004). The effectiveness of TCA was higher in large and multifocal HSILs. Side effects were common with both treatments, but no serious events were described. Tolerability was good in 77.1% and 80.7% of patients treated with ECA and TCA, respectively. At 24 months, recurrent HSIL were observed in 36.3% (95% CI: 27.3–45) and 28% (95% CI: 20.2–35.8) in the ECA and TCA groups (p = .049). A nadir CD4 cell count ≤200 cells/µl was found to be a risk factor for recurrence (OR: 1.77; 95% CI: 1.12–2.78).

Conclusions

In this study, treatment with TCA showed high effectiveness, low recurrence and good tolerability. Considering the benefits of TCA, it could be considered one of the first-line treatments for anal HSIL.

Keywords:

• High-grade squamous intraepithelial lesion
• human papillomavirus infection
• trichloroacetic acid
• electrocautery
• human immunodeficiency virus
• people with HIV
• anal dysplasia

Acknowledgments

We thank Springer Nature Author Services for the English language review. We also thank Santi Parez-Hoyos of the Statistics and Bioinformatics Unit (Vall d'Hebron Research Institute) for statistical analysis support.

Disclosure statement

J.B., A.C., J.G., P.S., J.N., and V.F. have received financial compensation for lectures, consultancy work, educational activities, and support for attending meetings from Gilead Sciences, Janssen-Cilag, Merck Sharp & Dohme and ViiV Healthcare, outside the submitted work. S.L. and J.H.-L do not report any financial disclosure.