Comparative analysis of anal colposcopy with histology in the follow-up of patients under treatment for anal condyloma

Objectives: To compare morphological abnormalities on anal colposcopy against histology to determine anal high-grade squamous intraepithelial lesions (HSILs). Methods: This is a retrospective data assessment of HIV-negative and HIV-positive patients undergoing outpatient follow-up. The sample comprised 54 patients presenting acetowhite lesions on anal colposcopy. Acetowhite lesions were classified according to their morphology into punctation, verrucous, mosaic, ulcerated, or hypervascularized, and biopsies of these specimens were classified as anal HSIL, low-grade squamous intraepithelial lesion (LSIL), or normal. The data were analyzed using SPSS forWindows version 13.0 (SPSS Inc., Chicago, IL, USA). The results were analyzed using the nonparametric Mann-Whitney test, the Fisher exact test and the chi-squared parametric test. A 95% confidence interval (CI) was used and a level of significance <5% was adopted for all statistical tests. Results Fifty-four patients (50 males, 80% HIV+) with biopsied acetowhite lesions were assessed. There were 31 punctation lesions, 1 classified as HSIL (3.2%; 95%CI: 0- 40.0), 17 verrucous lesions, 3 HSIL (17.7%; 95%CI: 0-10.7), and 1 ulcerated, classified as HSIL (100%), and 4 mosaic and 1 atypical vessel lesion, all classified as LSIL. The results showed no association of presence of anal HSIL with positivity for HIV infection or with counts above or below 500/µl in HIV+patients. Statistical analysis was performed using the Mann-Whitney nonparametric test, the Fisher exact test, and the chi-squared parametric test. Conclusion: The comparison of morphological findings on anal colposcopy against histology revealed no morphological pattern suggesting anal HSIL. (AU)

Detection and Typing of Human Papillomavirus in Anal Condyloma Acuminatum of HIV-positive Patients

PURPOSE: Anal condyloma is an epithelial proliferative lesion caused by human papillomavirus (HPV) infection. The present study analyzed the HPV types detected in HIV (+) Korean anal condyloma using PCR-based DNA microarray. METHODS: DNA was extracted from the condyloma tissue of 17 patients including 9 HIV (+) patients (M:F=15:2, mean age 35 years, 22~59 years). The 1st PCR was performed with a general primer on L1 region, and nested PCR on the products of the 1st PCR. PCR products were hybridized with a DNA chip. RESULTS: Fourteen patients (9 HIV (+), 5 HIV (-)) showed positive HPV DNA. Overall, type 6 was the most common (N=11), and type 11 (N=6), type 53 (N=3) in order. Among HIV (+) patients, type 6 was also the most common (N=7), then type 11 (N=5) and type 53 (N=3). In contrast to the HIV (-) patients, 5 patients (55.6%) proved to have multiple infections in HIV (+) patients (2 double, 2 triple, 1 quadruple infection). Four of 9 HIV (+) patients (44.5%) showed co-infection with high-risk HPV. CONCLUSION: Multiple infection and co-infection with high-risk types are more prevalent in HIV (+) condyloma patients compared to HIV (-) patients. HPV types on HIV (+) male anal condyloma are similar to those detected in the Korean female uterine cervix.

¿Radiocirugía o criocirugía en condiloma acuminado de localización anal? / Radiosurgery and the cryosurgery in the treatment of the anal condyloma acuminata

Se realizó un ensayo clínico abierto, controlado y aleatorizado, para comparar la eficacia terapéutica entre la radiocirugía y la criocirugía en el tratamiento del condiloma acuminado de localización anal en el período comprendido entre enero y marzo del 2005, en el Policlínico docente 'Ángel A. Aballí'. Se incluyeron 20 pacientes adultos con éste diagnóstico. Se formaron de manera aleatoria dos grupos de tratamientos de 10 pacientes cada uno. El primer grupo recibió radiocirugía de las lesiones en el policlínico docente 'Antonio Guiteras'. El segundo grupo recibió criocirugía de las lesiones en el policlínico docente 'Joaquín Albarrán'. La frecuencia con que se realizaron ambos tratamientos fue la misma (quincenal). La duración de ambos tratamientos fue la misma (6 semanas). La eficacia terapéutica fue evaluada dos semanas después de culminar el tratamiento, comparando el estado inicial y final de las lesiones. A los pacientes respondedores al medicamento se les realizó seguimiento trimestral durante un año para detectar posibles recidivas. El análisis pareado inicio-final demostró respuesta significativa al tratamiento en cada grupo. El grupo tratado con radiocirugía respondió significativamente mejor desde el punto de vista estadístico que el grupo tratado con criocirugía. Las tasas de recidivas fueron elevadas en ambos grupos. Los principales eventos adversos observados en el grupo II fueron: ardor y dolor en el momento de la aplicación del tratamiento, de intensidad leve y de desaparición espontánea en pocos minutos. Se demostró que la radiocirugía tiene una mayor eficacia terapéutica que la criocirugía en el tratamiento del condiloma acuminado de localización anal.

An open controlled and randomized clinical trial was carried out to compare the therapeutical effectiveness between the radiosurgery and the cryosurgery in the treatment of the anal condyloma acuminata in the time period comprised between January and March 2005 in the 'A. A. Aballí' teaching polyclinic. 20 adult patients with this diagnosis were included. Two groups of 10 patients each were created in the randomized way, applying a different therapeutical scheme in each case. These were: group I received radiosurgery in the 'Antonio Guiteras' teaching polyclinic and group II received application of cryosurgery in the 'Joaquín Albarrán' teaching polyclinic. The frequently of application of both treatments was the same (each two weeks in each group). The length of both treatments was the same (six weeks in each group). The therapeutical effectiveness was assessed a couple of weeks after completing the treatment, comparing the initial and final state of lesions. The patients who responded to the medicine were followed up quarterly during a year in order to spot possible relapses. The start-end comparative analysis showed an outstanding response to the treatment in each group. The group I (radiosurgery) showed better response than the group II (cryosurgery), there was statistically remarkable difference. The relapse rates were high in both groups. The major adverse events as observed in group II were: burning and pain at the time of treatment, of mild intensity and of spontaneous disappearance in a few minutes. The radiosurgery is better than the cryosurgery for the treatment of anal condyloma acuminata.