The effectiveness and tolerability of imiquimod suppositories to treat extensive intra-anal high-grade squamous intraepithelial lesions/warts in HIV-infected individuals. (October 2019)

• Record Type: Journal Article
• Authors: Fuertes, Irene; Bastida, Carla; Lopez-Cabezas, Carmen; Rodríguez-Carunchio, Leonardo; Ordi, Jaume; Mallolas, Josep; Cranston, Ross D; Blanco, Jose Luís
• Is Part Of: International journal of STD & AIDS. Volume 30:Number 12(2019)
• Page Start: 1194
• Page End: 1200
• Publication Date: 2019-10
• Subjects: Anal dysplasia -- effectiveness -- HIV -- human papillomavirus -- imiquimod -- tolerability; Sexually transmitted diseases -- Periodicals; AIDS (Disease) -- Periodicals; 616.951
• DOI: 10.1177/0956462419864506
• Languages: English
• ISSNs: 0956-4624

Abstract

Topical imiquimod is a potential treatment for intra-anal condyloma and squamous intraepithelial lesions caused by human papillomavirus (HPV). We aimed to assess the effectiveness and tolerability of imiquimod suppositories for the treatment of anal high-grade intraepithelial lesions (HSIL) and condylomas in HIV-infected patients. We conducted a retrospective analysis in a prospectively followed cohort. High-resolution anoscopy was used for diagnosis and assessment following treatment. Patients' tolerability was assessed with a self-administered survey. Ninety-five patients (94.7% men) were analyzed. All were on combination antiretroviral therapy. Median CD4 T-cell count was 690 cells/µL, 89% had undetectable plasma viral load. Response to imiquimod was seen in 46.3% (complete: 12.5%, partial: 33.8%) in the intent-to-treat analysis, and in 55.2% (complete: 14.9%, partial: 40.3%) in the on-treatment analysis. Higher response rates were observed for anal condyloma compared with HSIL. A significantly poorer response rate was observed in smokers and in individuals with lower nadir CD4 T-cell counts. Imiquimod tolerability was "good" in 57.1% (n = 36), "acceptable" in 33.3% (n = 21), and "poor" in 9.5% (n = 6). Systemic side effects were reported in 20.7% (n = 13). There was no association between treatment effect and tolerability. In conclusion, imiquimod stands as a well-tolerated option for the treatment of HPV-associated intra-anal pathology in HIV-infected individuals.