Health-Related Quality of Life and Sexual Functioning of HIV-Positive Men Who Have Sex with Men Who Are Treated for Anal Intraepithelial Neoplasia
BACKGROUND:
The
impact of the treatment of precursor lesions of anal cancer (anal
intraepithelial neoplasia) on health-related quality of life has not been
investigated.
OBJECTIVE:
This
study aimed to evaluate the impact of 3 treatment options for anal
intraepithelial neoplasia on health-related quality of life and sexual
functioning in HIV-positive men who have sex with men.
DESIGN:
The
prospective cohort was embedded in a randomized clinical trial evaluating the
optimal treatment of anal intraepithelial neoplasia.
SETTING:
This
study was performed at the HIV outpatient clinic of the Academic Medical
Center, Amsterdam, the Netherlands.
PATIENTS:
Included
in the study were HIV-positive men who have sex with men with anal
intraepithelial neoplasia.
INTERVENTION:
Treatment
with imiquimod (n = 54), topical fluorouracil (n = 48), or electrocautery (n =
46) was given for 16 weeks.
MAIN OUTCOME MEASURES:
Health-related
quality of life and sexual functioning were assessed before, during, and 4
weeks after treatment. Health-related quality of life was assessed using the
EQ5D, sexual functioning was assessed using items derived from the
International Index of Erectile Function, and the female sexual function index
adapted for anal intercourse.
RESULTS:
One
hundred forty-five patients (98%) completed at least 1 questionnaire. There was
a significant different pattern of change over time in health-related quality
of life among the 3 treatment groups. Patients in the imiquimod group were more
likely to report pain/discomfort at week 8 than patients in the electrocautery
group. Patients in the electrocautery group were more likely to report
anxiety/depression and were less satisfied with their overall sex life at week
16 than patients in the imiquimod and fluorouracil groups, and patients in the
electrocautery group were also more likely to report pain/discomfort and
problems with usual activities at week 20 than patients in the fluorouracil
group.
LIMITATIONS:
The
follow-up method differed slightly among treatment groups. There is no
standardized, validated sexual functioning questionnaire for HIV-positive men
who have sex with men.
CONCLUSIONS:
All
treatment options have a negative impact on aspects of health-related quality
of life. Electrocautery has significantly more negative effects on
health-related quality of life than imiquimod and fluorouracil and also has a
negative effect on sexual functioning.
- 11 Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands 2 Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands 3 Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands 4 Department of Psychology, Academic Medical Center, Amsterdam, The Netherlands 5 Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.
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