The Effectiveness of Trichloroacetic Acid vs Electrocautery Ablation for the Treatment of anal High-grade squamous intraepithelial lesion in HIV-infected patients.

BACKGROUND: Trichloroacetic acid (TCA) and Electrocautery (ECA) are two of the main treatment options for anal high-grade squamous intraepithelial lesion (HSIL). Our aim was to compare the efficacy and tolerance of TCA vs. ECA for HSIL METHODS:: Retrospective un-controlled study of HIV-infected men who have sex with men (MSM) who had an anal HSIL treated with TCA or ECA. On-treatment effectiveness was evaluated at 6-8 weeks after treatment. A complete response was defined as resolution of HSIL, a partial response as regression to low-grade lesion and recurrence as biopsy-proven HSIL during follow-up. A propensity-score analysis was used to adjust efficacy to potential confounding RESULTS:: From May-2009 to March-2018, 182 and 56 cases of anal HSIL were treated with ECA and TCA respectively. Comparing ECA with TCA, a complete response was observed in 33.5% (95% CI, 25.8-41.6) vs. 60.7% (50.0-74.8) and a partial response in 28.0% (20.3-36.0) vs. 23.2% (12.5-37.3), respectively (p<0.001). These differences were maintained in the propensity-score analyses. Side effects were common in both treatment, but tolerance was reported as good in 80.6% (74.2-89.2) and 82.6% (73.9-93.9) of cases treated with ECA and TCA respectively, and no serious events were described. Recurrence cumulative incidence for the first 12 months was 14.6% (9.1-23.1) for ECA episodes and 27.6% (11.5-57.7) for TCA (p=0.183) CONCLUSIONS:: Our study showed a higher efficacy of TCA than ECA with similar rates of side effects. In our opinion, considering the benefits of TCA, it should be considered as a first-line therapy for most anal HSIL management.