Table 2.
Ablative treatments
| Study | Design | N | Mean age | Male (%) | HIV-positive (%) | MSM (%) | High-grade AIN (%) | Treatment length | CR (%) | PR (%) | Recurred(%) | ASCC(%) | Follow-up (median in months) | Level of evidence | Bias score |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Electrocautery: HRA-guided destruction of AIN lesions | |||||||||||||||
| Chang et al. 2002 [26] | Prospective non-randomised open-label pilot study | 37 | 45 | 100 | 78 | 65 | 100 | - | 22 | 0 | - | - | 32.3 in HIV-negative and28.6 in HIV-positive(mean) | 4 | Moderate + |
| Pineda et al. 2008 [25] | Retrospectivechart review | 246 | 44 | 84 | 74 | - | 100 | One or multipletreatments ifcircumferential | 78 | - | 57 | 0.4 | 42 | 4 | Critical + |
| Marks et al. 2012 [29] | Retrospective chart review | 232 | 43 HIV-negative, 49 HIV-positive (median) | - | 57 | 100 | 100 | Up to 4 treatmentswith 3–4 months follow-upperiods | 67 (after4th treatment) | 0 | - | 0.4 | 17.3 in HIV-negative,13 inHIV-positive after 1st treatment | 4 | Moderate + |
| Richel et al. 2013 [12] | Open-labelRCT | 46 | 47 (median) | 100 | 100 | 100 | 54 | 4 months | 39 (40HGAIN) | 7 (12 HGAIN) | 28 | 0 | 4.5 (response)16.5 (recurrence) | 1b | Some concerns * |
| Assoumou et al. 2013 [27] | Retrospective chart review | 80 | 42 (median) | 100 | 56 | 100 | 90 | 1 treatment | 53 | - | - | 0 | - | 4 | Critical + |
| Burgos et al. 2016 [28] | Observationalcohort study | 108 | - | 100 | 100 | 100 | 100 | 2–4 treatmentsfollowed byHRA 6–8 weekslater. This wasrepeated untilclearance. | 25 | 26 | 13 | 0 | 12 (mean) | 4 | Moderate + |
| N = 749 | |||||||||||||||
| Infrared coagulation: after HRA, 1.5–1.6 second pulses under direct vision | |||||||||||||||
| Cranston et al. 2008 [32] | Retrospectivechart review | 68 | 45 (median) | 100 | 100 | 100 | 97 (lesions) | 1 treatment | 11 | 66 | - | 0 | 4.6 (mean) | 4 | Moderate + |
| Stier et al. 2008 [36] | 18 | 44 | 89 | 100 | - | 44 (lesions) | 1 treatment butretreated at 3 months ifpersistentdisease | 39 | 17 | 11 | 0 | 12 | 4 | Moderate + | |
| Goldstone et al. 2011 [33] | Retrospectivecohort | 143 | 42 HIV-positive; 36 HIV-negative | 100 | 48 | 100 | 67 | Up to 4treatments | 45 (after 4thtreatment) | - | - | 0 | 69 HIV-positive; 48HIV-negative | 4 | Serious + |
| Weis et al. 2012 [31] | Prospectivecohort | 124 | 40 | 80 | 100 | - | 100 | 1 treatment | 3 | 69 | - | 0 | 33 | 2B | Serious + |
| Sirera et al. 2013 [34] | Retrospectivecohort | 69 | 43 | 45 | 100 | 74 | 100 | 1 treatment, further treatment if recurrence | 71 | 6 | - | 0 | 25 (mean) | 4 | Moderate + |
| Goldstone et al. 2019 [35] | Non-blinded multisiterandomised controltrial (IRC vsobservation alone) | 120 | 49 treatedvs. 50.5untreated | 90 treated 97 vs. untreated | 100 | - | 100 | 1–3 treatments depending on response | 62 treated vs. 30 untreated | 7 treated vs. 6 untreated | - | 0 (both arms) | 12 | 1b | Some concerns* |
| N = 542 | |||||||||||||||
| Radiofrequency ablation: intravenous sedation and local anesthetic, 3 applications of energy at 12 J/cm2 | |||||||||||||||
| Goldstone et al. 2017 [37] | Prospective,non-randomisedopen-label pilot study;hemi-circumferentialRFA | 21 | 45 | 86 | 0 | - | 100 | 1 treatment. Further treatment if recurrence | 52 | - | 14 | 0 | 12 | 4 | Moderate + |
| Goldstone et al. 2017[38] | Prospective,non-randomisedopen-label pilotstudy: circumferentialRFA | 10 | 52 | 100 | 90 | - | 100 | 1 treatment. Further treatment if recurrence | 60 | 0 | 0 | 0 | 12 | 4 | Moderate + |
| N = 31 | |||||||||||||||
+ Robins I tool* Cochrane risk of bias tool