Initial Outcomes for HPV-related Anal Squamous Cell Dysplasia in an HIV-Negative Non-MSM Population

Abstract

Introduction: HPV-related anal dysplasia (high or low grade) has been well reported in high-risk (HR) patients (HIV+ status or immune suppressed transplant recipients). However, for all other patients, the data is extremely limited. This represents a single provider's HPV-related dysplasia outcomes data in patients not historically designated as HR. Methods: A retrospective study was performed on consecutive patients diagnosed with anal squamous cell dysplasia or superficially invasive squamous cell carcinoma (SISCCA) with a minimum follow-up of 12 months. Medical records were reviewed for information regarding demographics, pathology, cytopathology, and treatment and recurrence data. HIV-positive patients were excluded. Results: Forty-one patients were identified, 34 were female. Median age at diagnosis was 58 years (26–85) and median follow up was 26 months (12–51). Fifteen patients were referred following a colonoscopy, 12 second opinions, 10 for high-risk vulvar/cervical disease, 4 primary management. At diagnosis, 31 patients had HGAIN, 3 patients had LGAIN, 2 patients had L/HGAIN, and 5 had SISCCA. Following initial treatment (resection, fulguration, or topical), 19 (41%) patients developed recurrence at a median of 16 months (4–62) with 5 patients developing at least a 2nd recurrence at a median of 12 months (11–26). Two patients progressed to cancer at 9 and 14 months. HR HPV serotypes were reported in 16/30 patients with available anal cytology. Conclusions: HPV-related anal dysplasia in non-HR patients is clinically significant with anticipated recurrence and progression to cancer rates that warrant close follow up. These outcomes are comparable with current treatment and follow up when compared to the literature from HR patients. Though long term outcomes and higher number of patients are needed, initial outcomes of HPV-related disease in non-HR patients may display different behavior compared to HR patients suggesting differences in mechanisms leading to chronic infection and dysplasia.