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

Participants in the National AIDS Malignancy Conference grappled with the effect of highly active antiretroviral therapy (HAART) on cancer. HAART has sharply decreased rates of opportunistic infections in a number of studies, but its impact on AIDS is complicated. Kaposi's sarcoma (KS) rates have rapidly declined in the past few years, corresponding to the time that HAART has been the standard of care. However, the effects on non-Hodgkin's lymphoma are mixed. Researchers also report a higher risk of cervical cancer among HIV-positive women. Immune-suppressed populations experience higher rates of cancer than expected, but the correlation between HIV-induced immune suppression and AIDS malignancies is not likely to be worked out soon. Charts show how the rates of HIV-associated KS and primary CNS lymphoma have decreased recently, and show how HHV-8 seropositivity correlates to the number of sexual partners. Researchers are calling for the development of a diagnostic tool similar to Pap smears to identify early cases of anal cancer.
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PMID:Less cancer--or more--with HAART? Or, reflections on a late opus. 1136 31

A new study presented by Annekathryn Goodman of Massachusetts General Hospital indicates that HIV positive women should receive annual colposcopies, along with Pap smears, to detect abnormal cell growth early. The recommendation is due to the fact that HIV positive women are more likely to have false-negative Pap smears than HIV negative women. In a related development, the FDA approved a new DNA-based blood test to detect human papillomavirus, which is associated with cervical and anal cancer. In addition, the National Cancer Institute (NCI) notified physicians that it has changed its recommendation for cervical cancer treatment. NCI now recommends both chemotherapy and radiation therapy for women with metastasized cervical cancer.
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PMID:Annual colposcopies and pap smears recommended for women with HIV. 1136

Kaposi's Sarcoma (KS) is a type of cancer thought to be caused by the human herpesvirus-8 (HHV-8). KS causes cancerous lesions on or beneath the skin. The disease may overpower the immune system and, in some cases, cause death. Studies show that the transmission of HHV-8 is linked to sexual contact, either genital or oral, and that people cannot contract KS without first having HHV-8. The recent decrease in the number of KS cases has been attributed to the use of highly active antiretroviral therapy (HAART). However, the incidence of anal cancer among gay men with HIV is increasing. HAART may be prompting this trend by prolonging lives, and giving more time for the disease to develop. The progression of anal cancer is noted, along with information about available screening tests. Surgical and non-surgical treatments are listed. All men who engage in sex with men are urged to be screened for this type of cancer.
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PMID:The trouble with tumors. 1136 67

The effect of highly active antiretroviral therapy (HAART) on the natural history of anal squamous intraepithelial lesions (ASIL)-the likely anal cancer precursor-and anal human papillomavirus (HPV) infection is unknown. ASIL severity and level of anal HPV DNA were evaluated among HIV-positive men who have sex with men (MSM) for at least 6 months before initiation of HAART. The results were compared with those from a 6-month period after initiation of HAART. Anal swabs for cytology and HPV studies were obtained, followed by high-resolution anoscopy and biopsy. Among men whose most severe pre-HAART diagnosis was atypical squamous cells of undetermined significance or low-grade ASIL, 18% (confidence interval [CI], 6-31%, 7 of 38) progressed and 21% (CI, 8-34%, 8 of 38) regressed 6 months after starting HAART. Seventeen percent (CI, 0-38%, 2 of 12) of study subjects who began with a normal diagnosis developed ASIL. Only 4% (CI, 0-10%, 1 of 28) of study subjects with high-grade ASIL regressed to normal. There was no reduction in the proportion of study subjects who tested positive for HPV DNA or HPV DNA levels after HAART initiation. The ASIL and HPV data were similar to those of the pre-HAART comparison period. These results indicate that HAART has little effect on either ASIL or HPV in the first 6 months after HAART initiation.
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PMID:Effect of highly active antiretroviral therapy on the natural history of anal squamous intraepithelial lesions and anal human papillomavirus infection. 1174 29

As the AIDS epidemic progresses, more and more HIV-infected patients will develop malignancies. The natural history of a malignancy may change dramatically in the presence of HIV infection. Among the AIDS and non-AIDS malignancies, the most frequently reported solid tumors are cervical and anal cancer, testicular germ cell tumors, lung cancer, and skin cancer. Regardless of epidemiology and outcome, the natural history of the majority of non-AIDS-defining tumors changes in the setting of HIV infection. Physicians who treat patients with AIDS and non-AIDS-related cancers need to become familiar with antiretroviral agents, drug-drug interactions, and the prophylaxis and management of opportunistic infections.
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PMID:AIDS and non-AIDS-related malignancies: a new vexing challenge in HIV-positive patients. Part II. Cervical and anal squamous epithelial lesions, lung cancer, testicular germ cell cancers, and skin cancers. 1206 17

The incidence of malignancies has increased in conjunction with epidemic of human immunodeficiency virus (HIV) disease and they are currently considered acquired immunodeficiency syndrome (AIDS)-defining conditions. Approximately 40% of all patients with AIDS have developed cancer during the course of HIV infections. Further, as survival has improved in HIV disease, the incidence of these malignancies has increased. The main malignancies noted are Kaposi's sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease, rectal and anal cancer.
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PMID:[Neoplastic manifestations of HIV infection]. 1270 85

Risk factors for anal cancer include anal intercourse and infection with multiple strains of human papillomavirus, the causative agent of anal precancerous dysplasia. Several recent studies have shown that HIV-seropositive gay men are at greater risk for anal dysplastic lesions than seronegative gay men. Moreover, the risk for detection and progression of dysplastic lesions grows as the CD4+ cell count declines. A surgeon with a practice that includes gay men referred for anorectal disease presents data regarding the high prevalence of anal dysplasia in his patients.
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PMID:Anal dysplasia in men who have sex with men. 1272 7

Anal canal cancer rate is relatively high among HIV-positive patients, particularly in homosexual men, where it is twice that of HIV-negative homosexual men. As for uterine cervix cancer, it is possible that anal canal cancer is linked to human papillomaviruses (HPV): in fact, its oncogenic serotypes are found in 60% of tumours. Most of anal mucosa in HIV-positive patients is infected by HPV. It causes Anal Squamous Intraepithelial Lesions (ASTI): low grade and high grade squamous intraepithelial lesions, which can probably progress to invasive anal cancer. In the anal mucosa, HPV induces clinically flat condylomata. They generally are invisible and revealed only by acetic acid application. Sixty percent of seropositive gay men and 26% of seropositive women have anal ASTI. This rate is higher than in the general population. A decreasing of systemic and local immunity and so probable interactions between HPV and HIV could explain the frequency of anal ASTI among seropositive patients. Introduction of highly active antiretroviral therapy does not really influence the evolution of anal dysplasia. Screening of preneoplastic lesion is possible with anal Pap smear, and when it is positive, patients must undergo high resolution anuscopy. Cost effectiveness analyses indicate that only the highest risk group (HIV-positive gay men) should have anal screening. Only high grade squamous intraepithelial lesions have to he systematically treated, low grade squamous intraepithelial lesions could he simply followed up. The best treatment of anal dysplasia is surgical excision, with careful follow-up, because of high recurrence rate among seropositive patients.
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PMID:[Preneoplastic anal lesions and anal canal carcinoma]. 1285 Jul 63

Although not yet included in the Centers for Disease Control definition of AIDS, anal cancer clearly occurs more commonly in HIV-infected patients. An effective screening program for those groups who are at highest risk might be expected to impact rates of anal cancer just as significantly as did cervical Pap screening programs for the incidence of cervical cancer. Despite a relatively low rate of progression from AIN to invasive cancer, the scope of the problem is enormous based on the prevalence of anal HPV infection and the size of the HIV-infected, at-risk population. Thus, the potential benefits of screening, detection, and the development of more effective therapy also are enormous. Currently, therapeutic HPV vaccines for AIN represent an exciting avenue of research in HPV-related anogenital disease. Invasive anal cancer and HSIL (which is believed to be the precursor lesion) are expected to become increasingly important health problems for both HIV-infected men and women as their life expectancy lengthens. Although HAART may have improved the ability of many to tolerate CMT, it appears that toxicity of this therapy continues to be a problem for a proportion of HIV-infected subjects. The acute side effects present specific challenges to the clinician and patient, have an immediate impact on the patient's plan of care and dose intensity of the treatment, and ultimately may impact the outcome of the planned treatment. Late toxicity may influence the long-term quality of life. Small patient numbers, variable radiation therapy doses, limited information about viral load, and a potential confounding effect of higher CD4+ levels make it difficult to draw any conclusions about the effect of HAART on anal cancer outcome. Large, prospective studies will be required before solid conclusions about the impact of various factors on anal cancer prognosis and outcome can be drawn.
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PMID:Anal cancer: an HIV-associated cancer. 1285 59

Since the advent of HAART, the natural history of HIV disease has been changing, with decreased risk of life-threatening opportunistic infections and prolonged survival. Concurrently, a variety of non-AIDS-defining cancers have been reported with increased incidence in HIV-infected adults, including anal cancer, Hodgkin's disease, head and neck cancer, testicular cancer, lung cancer, colon cancer, basal cell cancer, squamous cell cancer of the skin, and melanoma. It appears that these tumors may have a more aggressive clinical course in HIV-infected people. Available data, however, suggest that antitumor response and survival in HIV-infected people with malignancy are improved in people with higher CD4 counts. The possible mechanisms for the increased incidence and altered clinical course of these malignancies in HIV-infected people remain unclear.
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PMID:Non-AIDS-defining cancer in HIV-infected people. 1285 61


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