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

HPV infection of both the genital tract and oral cavity of HIV+ men and women is increased. HPV-related pathology is also increased in the HIV+ individuals, usually with further increases seen for those HIV+ individuals with lower CD4 cell counts. Fortunately, the rates of cervical cancer and anal cancer are relatively low and not related to CD4 cell count. Treatment of the HIV+ individual with HPV-related disease is challenging and requires close long-term follow-up to prevent recurrent disease. The mechanism of how HPV and HIV interact is still not known but is more likely to be linked to immune suppression rather than a direct interaction between viruses. The newly developed HPV vaccines will likely have a significant impact on HPV-related disease in immunocompetent individuals. It remains to be seen what impact these vaccine will have on the immune depressed.
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PMID:Human papillomavirus infection and disease in the HIV+ individual. 1767 42

Anal intraepithelial neoplasia is considered to be a precursor lesion of invasive anal cancer. It is now increasingly recognized in high-risk groups, such as men who have sex with men and HIV-infected patients. Human papillomaviruses are considered to be an important aetiological agent in both anal intraepithelial neoplasia and anal cancer. Dermatologists are likely to encounter these conditions among the differential diagnoses to be considered in high-risk patients presenting with perianal and anal lesions. Anal cancer rates are also increasing among the HIV-infected and HIV-non-infected population. The successful treatment of anal intraepithelial neoplasia may reduce the risk of subsequent development of anal cancer. However, current therapies for anal intraepithelial neoplasia may be associated with treatment-related morbidity and are not well validated. It is currently not proven that they reduce the likelihood of the development of anal cancer. Nevertheless, screening for anal intraepithelial neoplasia is being advocated for high-risk groups and may become standard dermatological care for these patients. In view of recent developments in the understanding of this condition, this article reviews the current understanding of anal intraepithelial neoplasia and its treatment from a dermatological perspective.
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PMID:Anal intraepithelial neoplasia and anal cancer in dermatological practice. 1768 Sep 64

A retrospective review of the prevalence of intraepithelial neoplasia (IN) in surgically removed perianal/anal warts from December 1995 to December 2004 was undertaken in patients referred to the Sexual Health Clinic at Royal Perth Hospital. Data were analysed from 115 men and 38 women, 29 of whom had HIV infection (27 men and two women). Perianal/anal IN within the warts was found in 78% (52% high grade) of men with HIV infection. In men without HIV infection, the overall rate of IN within warts was 33% (20% high grade). The IN rate was 8.3% for HIV-negative women (2.8% high grade). Rates of IN within perianal/anal warts in men with or without HIV infection are higher than previously reported, and suggest the likelihood of a substantial increase in the future incidence of anal cancer. The association between IN and genital warts needs to be further studied.
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PMID:The frequency of high-grade intraepithelial neoplasia in anal/perianal warts is higher than previously recognized. 1768 15

Rates of cervical and anal human papillomavirus (HPV) infection and abnormal cytology are high in HIV-infected women, as are rates of anal HPV infection and abnormal cytology in HIV-infected men who have sex with men (MSM). Available evidence indicates that the incidence of anal cancer in HIV-infected MSM has increased in association with prolonged life expectancy achieved with antiretroviral therapy. Routine screening for cervical neoplasia is recommended for HIV-infected women. Routine screening is not yet universally recommended for anal neoplasia, although it should be considered for at-risk patients, particularly given recent improvements in local treatments. A preventive vaccine against cervical HPV infection is approved for use in young women before onset of sexual activity and acquisition of HPV infection. Its potential benefit in preventing anal infection in women and men has yet to be determined, and its potential utility in those with HIV infection remains unknown. This article summarizes a presentation on HPV infection in HIV-infected patients made by Joel Palefsky, MD, at an International AIDS Society-USA Continuing Medical Education course in Chicago in May 2007. The original presentation is available as a Webcast at www.iasusa.org.
Top HIV Med
PMID:Human papillomavirus infection in HIV-infected persons. 1772 Sep 98

Anal cancer is rare and this helps to explain why anal pre-neoplastic conditions are poorly understood, especially with regard to their natural history and management. Anal intraepithelial neoplasia is closely linked to human papillomavirus infection and is particularly common in homosexuals and in immunosuppressed patients, especially those with HIV/AIDS. The high regression rates of low-grade anal intraepithelial neoplasia may simply reflect inconsistent pathologic reporting. Higher grades of anal intraepithelial neoplasia may remain static for long periods of time in immunocompetent patients, but those with HIV/AIDS show early and rapid malignant transformation. In general, most anal pre-neoplastic conditions are best diagnosed by biopsy and treated by surgical excision, although local recurrence is a problem. In anal Paget's disease, it is important to ascertain, at the time of diagnosis, whether it is due to a primary in-situ apocrine-type of neoplasia of the anus or if the disease is secondary to an invasive primary carcinoma of the rectum.
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PMID:Anal intraepithelial neoplasia and other neoplastic precursor lesions of the anal canal and perianal region. 1799

Anal intraepithelial neoplasia III (AIN III) is a risk factor for anal cancer with poor curative results and high morbidity. High-resolution anoscopy (HRA) is a minimally invasive means of identifying and treating AIN III early. We retrospectively reviewed HRA in the treatment of AIN III in a community setting. From January 2002 through November 2005, 76 patients with AIN III diagnosed by anal Pap smear, colposcopy, or biopsy underwent HRA for diagnosis and treatment. Twenty-one patients with AIN III on initial HRA underwent follow-up HRA for reassessment and treatment at 6 months. Recurrence/persistence of disease was recorded and compared with patient characteristics. Of 21 patients with repeat HRA, four were HIV-negative and 17 were HIV-positive. Twelve of 21 (57%) had intraanal recurrence/persistence; nine of 21 (43%) had no AIN III. Eleven (92%) with recurrence were HIV-positive; one (8%) was HIV-negative. Three (75%) HIV-negative patients had no recurrence/persistence; one of four (25%) had recurrence; and 11 of 17 (65%) HIV-positive patients had persistence of disease. HRA is an alternative tool to treat AIN III and can be performed in a community setting yielding results comparable to the university setting. As the prevalence of AIN III increases, it will be more important for community surgeons to treat AIN III with HRA.
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PMID:Intraoperative high-resolution anoscopy: a minimally invasive approach in the treatment of patients with Bowen's disease and results in a private practice setting. 1818 90

Non-AIDS-defining cancers have recently gained more attention, and it appears that several of these cancers may be more common the the HAART era. By most accounts in the literature, the overall risk of non-AIDS-defining cancer in HIV-infected persons is 2 to 3 times that in the general population. In this article, we review the literature on 5 of the most common non-AIDS-defining cancers (Hodgkin disease, anal cancer, hepatocellular carcinoma, oral cancer, and lung cancer) in the pre- and post-HAART periods. It remains unclear whether earlier initiation (CD4+ cell count above 350/microL) of antiretroviral therapy may be beneficial in preventing non-AIDS-defining cancer. Further large-scale, randomized, prospective studies on this question are warranted.
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PMID:Non-AIDS-defining cancers: should antiretroviral therapy be initiated earlier? 1824 Apr 50

Anogenital human papillomavirus (HPV)-infection is common in HIV-infected men who have sex with men (HIV+MSM). These patients have a strongly increased risk of HPV-induced anal cancer and its precursor lesion, anal intraepithelial neoplasia (AIN), and a moderately increased risk for penile cancer. Only limited data exist on penile intraepithelial neoplasia (PIN) in HIV+MSM. We determined the prevalence and evaluated the virologic characteristics of PIN and AIN in 263 HIV+MSM. In case of histologically confirmed PIN (and AIN), HPV-typing, HPV-DNA load determination, and immunohistochemical staining for p16(INK4a) were performed. PIN was detected in 11 (4.2%) and AIN in 156 (59.3%) patients. Ten PIN patients also had AIN within the observation period. Four clinical types of PINs could be distinguished. High-risk-alpha-HPV-DNA was found in 10 PIN lesions, with HPV16 being the most frequent type. Infections with multiple HPV-types were common. All high-grade lesions had high-risk-HPV-DNA-loads > or = 1 HPV-copy/beta-globin-gene-copy. Cutaneous beta-HPVs were found in PIN and AIN, but beta-HPV-DNA loads were very low, irrespective of the histological grade. p16(INK4a) Expression was detectable in all PIN lesions and correlated both with the histological grade and with high-risk HPV-DNA loads. In view of the PIN prevalence found in our study, all HIV+MSM should be screened for PIN in addition to AIN screening.
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PMID:Penile intraepithelial neoplasia is frequent in HIV-positive men with anal dysplasia. 1838 60

Anal cancer is a rare disease in the general population, but the incidence of anal cancer is higher in certain at-risk groups, such as men who have sex with men (MSM), and immunosuppressed individuals, including those with HIV infection. Among HIV-positive MSM, the incidence of anal cancer may be as high as 10 times greater than current rates of cervical cancer in the general population of women. Anal cancer is associated with human papillomavirus (HPV) infection and may be preceded by high-grade anal intraepithelial neoplasia (HGAIN). HGAIN and anal HPV infection are both highly prevalent in groups at risk for anal cancer. Current issues include determining the effect of antiretroviral therapy on the natural history of HGAIN and the incidence of anal cancer, optimizing diagnostic and therapeutic approaches to HGAIN, and determining the potential for prophylactic HPV vaccines to prevent anal HPV infection and anal cancer in at-risk groups.
Curr HIV/AIDS Rep 2008 May
PMID:Human papillomavirus and anal neoplasia. 1851 Aug 93

Despite the impact of combination antiretroviral therapy (cART) on HIV-related mortality, malignancy remains an important cause of death in the current era. Although the advent of cART has resulted in reductions in the incidence of Kaposi's sarcoma and non-Hodgkin's lymphoma, non-AIDS-defining malignancies present an increased risk for HIV-infected patients, characterized by some common clinical features, generally with a more aggressive behavior and a more advanced disease at diagnosis, which is responsible for poorer patient outcomes. Specific therapeutic recommendations are lacking for these new nonopportunistic malignancies, such as Hodgkin's lymphoma, anal cancer, lung cancer, hepatocarcinoma, and many others. Antiretroviral agents have a propensity for causing drug interactions as a result of their ability to either inhibit or induce the cytochrome P450 (CYP) enzyme system. Because many antineoplastic drugs are also metabolized by the CYP system, coadministration with cART could result in either drug accumulation with increased toxicity, or decreased efficacy of one or both classes of drugs. Further research delineating the combined safety and pharmacokinetics of antiretrovirals and antineoplastic therapy is necessary. Special considerations of these AIDS-related and non-AIDS-related malignancies and their clinical and therapeutic aspects constitute the subject of this review.
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PMID:AIDS-related malignancies: state of the art and therapeutic challenges. 1859 44


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