The purpose of this study is to see if curcumin can reverse anal high-grade squamous intraepithelial lesions (aHSIL) (high-grade anal precancerous cells or high-grade abnormal cells) in people living with HIV to avoid current treatments such as ablation (destroying abnormal cells with heat or surgical excision (cutting out the abnormal cells)), which have potential short- and long-term side effects.

This proposal suggests conducting a Phase I clinical trial using a 3 + 3 dose escalation approach to assess the safety and determine the maximum tolerated dose of intra-anal curcumin in individuals with HIV who have anal high-grade squamous intraepithelial lesions (aHSIL/AIN 2-3). Currently, there is a significant need for non-surgical treatments for pre-malignant anal diseases in people with HIV, aiming to reduce risks and complications associated with existing surgical and topical interventions.

Curcumin, a compound derived from turmeric, is known for its anti-inflammatory and anti-infectious properties. While previous research has shown its anticancer effects in oral doses, its bioavailability is limited, and intra-anal administration has not been studied in humans. This trial aims to explore the potential of intra-anal curcumin as an alternative treatment for aHSIL in people with HIV.

The study will involve enrolling participants with aHSIL and administering increasing doses of curcumin intra-anally for 14 days, following the 3 + 3 dose escalation model. The trial will continue until the dose-limiting toxicity (DLT) level is reached, and participants report symptoms necessitating a dose reduction.

To enhance future studies, the researchers will also evaluate patient and male partner acceptability through questionnaires. The insights gained from this trial will guide the design of subsequent efficacy and safety studies for individuals with AIN 2 and 3 neoplasia.

Major Inclusion Criteria:

• 30 and older
• Have biopsy-proven anal intraepithelial neoplasia (AIN) 2, AIN 3 without previous treatment
• Or cytology results for ASC-H or HSIL
• Able and willing to complete Study Diary
• Other inclusion criteria apply

Exclusion Criteria:

• Have a clinically significant chronic medical condition that is considered progressive, such as but not limited to coronary disease, congestive heart failure, chronic obstructive lung disease, and diabetes mellitus. Chronic nonprogressive or intermittent syndromes are not excluded, including migraine headaches, mild reactive airway disease, controlled hypertension, stable pain syndromes, or benign gastric reflux.
• Have any history of anal cancer malignancy.
• Pregnant or planning to become pregnant in the next three months.
• Have a history of sensitivity or allergy to any compound used in this study.
• Have Grade 2 or higher renal or hematology abnormality,
• Are currently using, or in the last year have used intravenous drugs (except for therapeutic use), recreational drugs, or alcohol abuse.
• Other exclusion criteria apply

Deidentified Individual participant data that underlie the published results will be made available for sharing.

Data will be available from December 2025 to January 2031.

Data will be available for sharing with researchers providing a methodologically sound proposal, to achieve aims in the approved proposal. Proposals should be directed to lflowe2@emory.edu. The data requestor needs to sign a data access agreement to gain access.