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Imiquimod 5% cream for five consecutive days a week in an HIV-infected observational cohort up to 32 weeks in the treatment of high-grade squamous intraepithelial lesions
  1. Eric Martin van der Snoek1,
  2. Jan Christiaan den Hollander2,
  3. Marchina Elisabeth van der Ende3
  1. 1Department of Dermatology and Venereology, Erasmus MC, Rotterdam, The Netherlands
  2. 2Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
  3. 3Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr Eric M van der Snoek, Department of Dermatology and Venereology, Erasmus MC, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands; e.vandersnoek{at}


Objectives The incidence of anal cancer is increasing especially in HIV-positive men having sex with men. Screening for the cancer precursor, high-grade squamous intraepithelial lesions (HSIL), is challenging, as current treatment is suboptimal. The aim of this prospective study was to establish the efficacy of five consecutive days a week self-administered treatment with imiquimod 5% cream for both perianal and intra-anal HSIL and to assess the adverse effects and burden of this regimen.

Methods 44 patients with histologically proved perianal or intra-anal HSIL were treated with a five consecutive days a week imiquimod 5% cream regimen. When no response could be confirmed after the first 16 weeks of therapy, patients were encouraged to continue the use of the cream for a further 16 weeks. Side effects were routinely assessed.

Results Complete or partial response was observed in 20 (45%) of 44 patients with HSIL after 16 weeks of treatment; another nine patients showed complete or partial response after an additional 16 weeks of treatment, resulting in a response rate of 29 (66%) out of 44 patients.

Conclusions Topical imiquimod 5% cream is useful in HSIL. A five consecutive days treatment regimen with imiquimod 5% cream for HSIL does not seem to be more effective compared with the customary prescription for 3 days a week. A prolonged course of imiquimod 5% cream is warranted for intra-anal HSIL. Adverse effects are comparable between 3 and 5 days treatment regimen.

  • HIV
  • HPV

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