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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence and variety of solid tumors reported among human immunodeficiency virus (HIV)-infected individuals are increasing. Among the most common of these tumors are anogenital malignant and premalignant tumors associated with human papillomavirus infection. Cervical intraepithelial neoplasia is one such human papillomavirus-associated lesion and appears to be more common among women with HIV infection than HIV-negative women. Cervical intraepithelial neoplasia also appears to progress more rapidly among HIV-positive women, and these women are at high risk for progression to invasive cervical cancer in the absence of rigorous screening, treatment, and follow-up. Likewise, HIV-positive men with a history of receptive anal intercourse have a high prevalence of anal intraepithelial neoplasia and a rapidly increasing incidence of invasive anal cancer. The approach to the prevention of anal cancer is similar to that of cervical cancer, although experience with diagnostic and treatment measures is still limited for anal disease. As individuals with advanced immunosuppression live longer due to improvements in the medical therapy for HIV infection, it is expected that the incidence of human papillomavirus-associated neoplasia, as well as that of other tumors, will continue to increase.
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PMID:Human papillomavirus-associated anogenital neoplasia and other solid tumors in human immunodeficiency virus-infected individuals. 166 Nov 70

The acquired immune deficiency syndrome (AIDS) has been characterized by aggressive malignancies and infections with unusual presentations. There is a well-documented association between cervical dysplasia and the development of cervical carcinoma, and more recent evidence of an association between cervical dysplasia and HIV infection. The course of coexistent HIV infection and cervical cancer has not been well described. We report a patient with HIV infection and a stage IIIB squamous cell carcinoma of the cervix who, despite adequate treatment, had rapid disease progression as well as metastasis to an unusual iliopsoas muscle site in association with an abscess. As HIV becomes more prevalent in the female population, an increased frequency of rapidly progressive cervical carcinoma may be forthcoming. Improved life expectancy of HIV-infected patients due to modern medication is anticipated, causing a cervical neoplasm to have a more prominent effect on prognosis. Close surveillance with frequent Pap smears and colposcopies as well as aggressive management of cervical dysplasia and carcinoma in HIV-infected patients is suggested as is thorough patient counseling.
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PMID:Rapidly progressive squamous cell carcinoma of the cervix coexisting with human immunodeficiency virus infection: clinical opinion. 186 5

Using recent data from the U.S., the argument is reiterated that sexually transmitted diseases (STDs) have serious consequences on female morbidity, mortality, pregnancy outcome and that the cost of screening and treatment can afford significant savings. Since the rosy view of the 1950s that STDs had been eliminated with penicillin, new viral, parasitic and bacterial forms have emerged, and antibiotic-resistant classical STDs have increased yearly. 13 million new cases were reported in 1989, excluding non-reportable diseases and asymptomatic infections, such as over half of chlamydia cases. Mortality is possible from STDs, most notably from AIDS, now among the top 5 causes of death of women aged 15-44. Other fatal outcomes are cervical cancer related to human papilloma virus, accelerated by HIV, pelvic inflammatory diseases (PID) its consequences, ectopic pregnancy. Symptomatic PID affects 1 million women, resulting in 210,000 hospitalizations per year. Ectopic pregnancy accounts for 12% of maternal mortality. STDs are involved in neonatal infections with HIV, syphilis, gonorrhea, chlamydia, cytomegalovirus, and herpes. Chorioamnionitis, a finding in many miscarriages, is caused by many of the same organisms. Several studies have projected sizeable potential savings, even within the current year, by providing STD screening and treatment in family planning clinics and prenatal care, in terms of prevention of hospitalization of women, and intensive care for low birth weight, premature and infected newborns.
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PMID:An ounce of prevention ... STDs and women's health. 193 19

This overview provides a discussion of the special concerns of sexually transmitted diseases (STDs) for women, particularly because of its asymptomatic character; screening; primary prevention; e.g., abstinence, selection of sexual partners restriction of sexual activities, use of barriers (condoms, vaginal spermicides, diaphragm in conjunction with spermicides), and vaccines; and the role of the gynecologist in StD prevention. Gonorrhea and chlamydial infection are usually asymptomatic STD infections in women; long term sequelae are pelvic inflammatory disease (PID), infertility, and pregnancy complications. There is an increased risk of cervical cancer. Infection is lifelong for herpes simplex virus (HSV) and HIV and malingering for chronic hepatitis B (HPB). Genital human papillomavirus (HPV) and HSV infections cannot be identified serologically. The fetus can be fatally or severely affected by STDs. Abstinence is the only effective prevention for STDs. Likelihood of infection may be reduced by limiting partners, but how partners are chosen and knowledge of infection is a more important determinant. Partners need to be asked about current symptoms, history of STDs, multiple partners, and history of known STD partners, as well as past history of homosexual activity, intravenous drug use, hemophilia, and previous exposure to high-risk persons for STDs. Visible genital warts or lesions, wartlike growths, ulcers, or rash need explanations. Avoidance of oral anal and digital anal activity reduces transmission of hepatitis A, giardiasis, amebiasis, and shigellosis. Any mechanical barrier that remains intact should reduce the risk of STD; barriers specifically covering the cervix are excellent. Condom use is effective when used as follows: 1) at the onset of sexual activity, 2) without petroleum jelly or baby oil on latex, 3) with care of fingernails which may tear holes, 4) with complete withdrawal of the penis before complete detumescence, and 5) with a withdrawal hold at the base of the penis. Spermicides, such as nonoxynol 9, are effective against STDs. Diaphragm use with spermicide may be effective because of the spermicide. There is a reduced risk of transmission of HSV or HPV to a partner. Vaccines are only available for hepatitis B. Obstetrics and gynecology residency training in STDs in unavailable in 4 out of 5 medical schools, and gynecologists are ethically obligated to accurately inform about STD diagnosis, treatment, and diagnosis.
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PMID:Avoiding sexually transmitted diseases. 209 42

In incidence and epidemiology of sexually transmitted disease (STD)s in Southeast Asia and the Western Pacific, with gonorrhea, chancroid, nongonococcal urethritis, syphilis, genital herpes and genital warts at the forefront, are reviewed. The bacterial STDs gonorrhea, chancroid and syphilis are the major problems. Gonorrhea is the most prevalent STD in the region, with a high incidence of chromosomally-mediated resistant and penicillinase-producing strains comprising 35-53% of isolates. Clinical treatment failures due to spectinomycin-resistant gonococci are reported as increasing. Uncontrolled antibiotic sales are blamed for these resistant strains. Syphilis has declined in the 1950s, but has re-emerged. Chancroid is declining, while herpes is making up a greater share of ulcer disease. nongonococcal genital infection and chlamydia are thought to be the 2nd most common infection, however most centers do not have the facilities to isolate chlamydia. Genital warts are becoming a common cause for attendance at STD clinics and are a concern for cervical cancer. Prostitutes are most often cited as the source of male STD infection. The anonymity and large number of contacts of the sex industry, and high mobility of the indigenous population and of tourists are considered central in STD transmission. The high incidence of STDs in this area is a harbinger of future trends of HIV/AIDS in Asia.
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PMID:The epidemiology of sexually transmitted diseases in Southeast Asia and the western Pacific. 211 64

The Italian Cooperative Group on AIDS-related tumors has collected 435 cases of HIV-associated tumors since December 1986. The following conclusions can be drawn from this IVDA-based series: (1) at least 15% of AIDS cases are associated with tumors; (2) the number of malignant lymphomas (high-grade non-Hodgkin's lymphoma [NHL], Hodgkin's disease [HD] is comparable to that of Kaposi's sarcoma (KS) (188 vs. 198); (3) KS among AIDS patients is less common than in countries where homosexual men are the main group affected by AIDS. However, KS also affects intravenous drug abusers (IVDA) almost exclusively males, with characteristics similar to those observed among homosexual men; (4) HD is associated with an aggressive course; (5) anal and oral primary tumors as well as oral and anal involvement of NHL are very rare; (6) testicular cancers occur in patients mainly with early HIV infection, without adversely affecting the dosage of radiotherapy and chemotherapy; (7) cervical cancer successfully treated with conization suggests that PAP test screening in young IVDA women is warranted; (8) lung cancer occurs in a young age group with rapid progression and death.
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PMID:Characterization of AIDS-associated tumors in Italy: report of 435 cases of an IVDA-based series. 220 42

To determine the relationship between human immunodeficiency virus (HIV) infection and cervical neoplasia, the characteristics of invasive and preinvasive cervical disease in 114 patients of known HIV status were assessed. Seven of thirty-seven patients (19%) under age 50 with invasive cervical carcinoma were HIV-positive, including a 16-year-old with stage IIIB disease. HIV-positive patients had more advanced invasive cancer than HIV-negative patients. Disease persisted or recurred in all HIV-positive patients compared to 37% of HIV-negative patients. In HIV-positive patients, the median times to recurrence and death were 1 and 10 months, respectively. No HIV-positive patient had HIV-related symptoms. The mean T4:T8 cell ratio in HIV-positive patients was 0.49, compared to 1.86 in HIV-negative patients. The mean T4 cell count was 362/mm3 in HIV-positive and 775/mm3 in HIV-negative patients. Colposcopic evaluations of the lower genital tract of 77 patients with abnormal smears revealed higher-grade cytology and histology in 25 HIV-positive than in 52 HIV-negative patients. HIV-positive patients had significantly more multifocal/extensive lesions, multisite involvement, perianal involvement, evidence of human papillomavirus (HPV) infection, and associated gynecologic infections than HIV-negative patients. In areas at high risk for HIV infection, we must anticipate a high prevalence of HIV seropositivity in women with invasive cervical cancer. In the HIV-infected, cervical cancer is of advanced stage and responds poorly to therapy. Intraepithelial neoplasia in HIV-positive patients may be of higher grade than in HIV-negative patients, with more extensive involvement of the lower genital tract.
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PMID:Human immunodeficiency virus infection and cervical neoplasia. 222 52

Progestins counteract the positive effect of the estrogen component in oral contraceptives (OCs) on cholesterol levels thus increasing the risk of atherosclerosis. Low androgenic potency progestins do not have a negative effect, however. Other research indicates that the lower the estrogen dose in OCs the lower the risk of deep vein and superficial thrombosis. OC users, especially low dose OC users, with no other risk factors (e.g. smoking and hypertension) are not at increased risk of cardiovascular disease. Some research demonstrates elevated risk of stroke in OC users, however. Elevated cholesterol, obesity, diabetes and other factors further increases the risk of stroke. Combined OCs protect against endometrial and ovarian cancer and this effect increases with use and continues after use. Moreover OC users are not at increased risk of pituitary adenoma. Results of some studies shows an increased risk of cervical cancer, but other only demonstrates a slight increase. So far research does not indicate the following to increase breast cancer risk among OC users: early age at 1st OC use, formulation, family history, and history of benign breast disease. There is an increased risk for liver tumors in OC users, nevertheless it is rare. OCs do not raise the risk of diabetes or gallbladder disease. High dose formulations increases the risk of high blood pressure, but not so with low dose formulations. OC use does not impair, fertility, but delayed conception often occurs. Most research demonstrates no increase in pelvic inflammatory disease in OC users. OCs do not cause congenital malformations. Combined OC use is contraindicated for breast feeding mothers, but progestin only OCs can be used with no advance effects. Results of 1 study demonstrates an increase in HIV infection in OC users, but another study has opposite results. The article concludes with recommended clinical management practices.
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PMID:Reassessment of the metabolic effects of oral contraceptives. 185 68

Many malignancies occur in association with the acquired immunodeficiency syndrome (AIDS). The incidence of cervical intraepithelial neoplasia is increased in patients with human immunodeficiency virus (HIV) infection, although coexistent HIV infection and cervical cancer have not been described. We describe a patient with HIV infection and a stage IIB, poorly differentiated cervical carcinoma who initially responded well to standard radiation therapy. Relapse at an unusual periclitoral site as well as disseminated carcinomatosis appeared within 2 months. Despite chemotherapy with cisplatin, bleomycin, and mitomycin C, the patient died within 3 months of relapse. This pattern of aggressive tumor behavior may occur more frequently as HIV infection spreads into the heterosexual population. We recommend frequent pelvic and cytologic examinations of HIV-infected women and the consideration of an aggressive treatment approach should invasive carcinoma be detected.
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PMID:Rapidly progressing cervical cancer in a patient with human immunodeficiency virus infection. 231 57

The data available for the epidemiology of AIDS and HIV infection among women in the Federal Republic of Germany describe the distribution of risk groups to urban areas. The highest rates of seroprevalence are found in cities like Berlin, Munich and Frankfurt. These data do not support the initial fear of an explosive heterosexual spread in the female population. Since 1986 the incidence of pregnancies of HIV-infected women in Berlin has remained constant. The number of pregnancies carried to full term decreased because of an increased number of terminations. Another growing problem are gynecological complaints, depending on the duration of the HIV infection, ranging from repeated infectious diseases of the genitals to cervical cancer.
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PMID:[Epidemiology and clinical aspects of the HIV-infected female]. 280 2


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