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Durability of Initial Antiretroviral Therapy in a Resource-Constrained Setting and the Potential Need for Zidovudine Weight-Based Dosing

2009; Lippincott Williams & Wilkins; Volume: 53; Issue: 2 Linguagem: Inglês

10.1097/qai.0b013e3181bc0f10

1944-7884

James H. Willig, Juan Echevarria, Andrew O. Westfall, David A. Iglesias, Germán Henostroza, Carlos Seas, Michael J. Mugavero, Jeroan J. Allison, Jorge Paz, Fiorella Hernandez, C Tomatis, Michael S. Saag, Eduardo Gotuzzo,

HIV-related health complications and treatments

Anal intraepithelial neoplasia (AIN), particularly AIN 3 is a precursor to anal cancer. Most cases of AIN are intraanal, but few treatments for intraanal AIN are currently available. Topical 85% trichloroacetic acid (TCA) is an inexpensive method used to treat perianal condyloma, a form of AIN 1, but its efficacy to treat intraanal AIN as first-line therapy is unknown.Retrospective review of medical records was performed for all patients with AIN treated at the University of California San Francisco Anal Neoplasia Clinic with TCA as the first-line therapy from January 2000 to December 2004. Clearance was defined as the absence of AIN confirmed by high-resolution anoscopy and cytology after up to 4 TCA treatments.Thirty-five HIV-positive men and 19 HIV-negative men met the enrollment criteria. In multivariate analysis, greater clearance was seen in patients 41-48 years of age versus >49 years [odds ratio (OR): 8.4, confidence interval (CI): 1.1 to 94, P: 0.04]. Among HIV-positive men, those with 2 or fewer lesions showed greater clearance (OR: 14.3, CI: 1.5 to 662, P: 0.01). 32% of patients with AIN 2/3 cleared to no lesions. On a per lesion basis, 73% of AIN 1 and 71% AIN 2/3 cleared to no lesion or AIN 1 or less, respectively.Topical 85% TCA was safe and well tolerated. It was more effective in younger patients and among HIV-positive patients, those with 2 or fewer lesions. A high proportion of AIN 2/3 lesions responded to TCA treatment.