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

During the past three decades, anal cancer has served as a paradigm for the successful application of chemoradiation to solid tumors. Since the early 1990s, the increasing incidence of anal cancer in homosexual men has highlighted the causative role of oncogenic human papilloma-virus infection. This review focuses on significant trends and developments in the management of patients with squamous cell carcinoma of the anal canal, emphasizing three major aspects of diagnosis and treatment: routine screening and eradication of premalignant lesions in high-risk individuals; outcome of chemoradiation therapy in HIV-positive individuals in the era of highly active antiretroviral therapy; and potential improvements in chemoradiation protocols through improved radiation delivery technique and the combination of mitomycin with cisplatin in current prospective randomized trials.
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PMID:Diagnosis and management of anal cancer. 1879 27

Despite the impact of combined antiretroviral therapy (cART) on human immunodeficiency virus (HIV)-related mortality, malignancies remain the second most common cause of death in HIV infection in developed countries. In addition to the AIDS-defining malignancies, other cancers such as Hodgkin's lymphoma and anal cancer, are more frequent in HIV-infected patients who survive longer even though they do not have complete immune restoration The use of concomitant antineoplastic chemotherapy and cART have been demonstrated to be feasible and effective in patients with HIV-related malignancies; however, many drugs used in cART regimens have the potential for causing drug interactions as a result of their ability to either inhibit or induce the cytochrome P450 (CYP) enzyme system. Since many antineoplastic drugs are also metabolised by the CYP system, co-administration with cART could result in either drug accumulation and possible toxicity, or rapid drug metabolism and decreased efficacy. Unfortunately, very limited prospective interaction data are available to safely guide the combined use of cART and chemotherapy. This paper reviews the potential drug interactions and therapeutic considerations of the antiretroviral agents used to treat HIV and the most common anticancer agents used in the treatment of malignancies found in patients with HIV infection.
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PMID:Drug interactions between antineoplastic and antiretroviral therapies: Implications and management for clinical practice. 1907 May 6

HIV-infected patients are at increased risk for persistent human papillomavirus (HPV) infection, the major cause of anogenital cancer. The present study describes the HPV prevalence in urine samples of 243 HIV-infected men and a control group of 231 men. HPV DNA was amplified by the SPF10 polymerase chain reaction primer set. The overall HPV prevalence in HIV-infected men was 27.5% compared with 12.6% in controls (P < 0.01). Infections with high-risk and multiple HPV genotypes were present in both groups. Differences were not statistically significant. A multivariate logistic regression model showed a decreased HPV prevalence associated with use of a nucleoside and a non-nucleoside reverse transcriptase inhibitor combination (P = 0.03). A trend was observed towards a higher HPV prevalence and a lower CD4 cell count. Further prospective studies are needed to determine the role of HPV DNA testing in urine in future screening programmes for anal cancer in men.
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PMID:Effect of HIV viral load, CD4 cell count and antiretroviral therapy on human papillomavirus prevalence in urine samples of HIV-infected men. 1930 72

The use of antiretroviral therapy has reduced mortality and shifted the spectrum of malignancies affecting people living with HIV/AIDS (PLWH). We review guidelines and evidence for screening PLWH for non-AIDS-defining malignancies as compared with the general population. Cervical cancer screening clearly differs for HIV-seropositive women, with two Pap tests 6 months apart in the first year and then annually if normal. The role of cervical human papillomavirus screening has not yet been defined in HIV-seropositive women. Anal cancer screening consists of an annual digital rectal examination, and some (but not all) guidelines also recommend annual anal Pap tests. Screening for breast and colorectal cancer should follow standard, age-appropriate screening recommendations that apply to the general population. Screening HIV-infected men for prostate cancer, as with the general population, lacks a clear benefit. Despite increasing rates of hepatocellular carcinoma and lung cancers among PLWH, there is insufficient evidence to support routine screening.
Curr HIV/AIDS Rep 2009 May
PMID:Screening HIV-infected patients for non-AIDS-defining malignancies. 1935 79

Management of patients with squamous cell carcinoma of the anus (SCCA) has remained virtually unchanged since the 1980s. By contrast, the demographics of SCCA are evolving, with the emergence of a high-risk group of patients: HIV-positive male homosexuals are prone to develop anal intra-epithelial neoplasia and rapidly progress towards invasive SCCA. By many aspects, anal cancer is similar to uterine cervix cancer - a sexually transmitted disease driven by oncogenic human papillomavirus (HPV) infection. Thus, for many patients, SCCA results from the combination of two preventable diseases, HPV and HIV infection. This article reviews current evidence suggesting that a new, more preventive approach is needed in order to improve the clinical outcome of SCCA in HIV-positive patients.
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PMID:Prevention, chemoradiation and surgery for anal cancer. 1937 1

Human papillomavirus (HPV) is one of the most common sexually transmitted infections world-wide. Low-risk HPV-types are associated with genital warts. Persistent infection with high-risk HPV-types is associated with genital cancers. Smoking and HIV infection have consistently been associated with longer duration of HPV infection and risk for genital cancer. There is an increasing incidence of anal cancers, and a close association with HPV infection has been demonstrated. Receptive anal sex and HIV-positive status are associated with a high risk for anal cancer. Two HPV vaccines are now available and offer protection from infection by the HPV-types included in the vaccine. This benefit is maximally seen in young women who were uninfected prior to vaccination.
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PMID:Human papillomavirus and genital cancer. 1943 75

The incidence of invasive anal squamous cell carcinoma, a human papilloma virus (HPV) related cancer, is on the rise, especially in HIV positive men who have sex with men (MSM). Like cervical cancer, anal cancer is associated with precursor lesions detectable on exfoliative cytology as squamous intraepithelial lesions and on biopsy as intraepithelial neoplasia. Anal-rectal cytology screening programs, similar to cervical cytology screening programs, have been developed in an effort to detect and to eradicate precursor lesions prior to progression to invasive squamous cell carcinoma. Either conventional or liquid-based anal-rectal cytology specimens are acceptable, but liquid-based specimens are preferred. Specimens may be collected by health care professionals or by patients. A minimum of 2,000-3,000 nucleate squamous cells should comprise adequate specimens. Diagnostic terminology as defined by the Bethesda System for Reporting Cervical Cytology (TBS 2001) should be used. Sensitivity and specificity of a single anal-rectal cytology specimen is comparable with that of a single cervical cytology test, but cytological interpretations do not always correlate with lesion severity. Patients with atypical squamous cells of undetermined significance (ASC-US) or worse should be referred for anoscopy.
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PMID:Anal-rectal cytology: a review. 1994 74

Anal dysplasia is common in HIV patients, especially in HIV-positive men having sex with men (MSM). High-grade anal dysplasia can progress to invasive anal cancer. As in cervical carcinoma, there is a cause and effect relationship between anal cancer and human papillomavirus (HPV) infection, especially with high-risk types such as HPV16. Several experts have recommended screening programs for anal cancer, including anal cytology along the lines of the Pap smear in women. Such screenings should only be performed if pathological findings result in further diagnostic steps and, if necessary, appropriate treatment. Clinical inspection, lesion biopsy, and treatment of anal dysplasia are performed under high-resolution anoscopy. Anal cancer is divided into cancer of the anal margin and cancer of the anal canal. This classification is important because of the difference in treatment regimens. Early cancer of the anal margin is excised akin to squamous cell cancer of the exposed skin, whereas cancer of the anal canal is treated by radiochemotherapy. HIV-positive and HIV-negative patients have similar response rates to combined radiochemotherapy. However, side effects, especially acute post-irradiation skin toxicity, early local recurrences, and abdominoperineal rectal excision are more common in HIV-positive patients. Physicians working in the field of HIV/AIDS should regularly screen their patients for the presence of anal dysplasia and anal cancer. Basic diagnostic workup includes clinical inspection of the perianal area, digital rectal examination, and anal cytology.
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PMID:[Anal intraepithelial neoplasia and anal carcinoma: an increasing problem in HIV patients]. 1996 33

We prospectively evaluated 28 triple-class experienced HIV-1-infected patients harbouring R5 virus, who received maraviroc, raltegravir and etravirine. By on-treatment analysis, 26 (92%) had less than 50 copies HIV-RNA/ml at week 48. The median (interquartile range) 48-week increase in CD4 cell counts was 267 (136-355) cells/microl. Three serious adverse events occurred: one recurrence of mycobacterial spondylodiscitis, one anal cancer, one Hodgkin lymphoma. Although long-term safety needs further study, this protease inhibitor and nucleoside analogue-sparing regimen showed sustained efficacy.
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PMID:Raltegravir, maraviroc, etravirine: an effective protease inhibitor and nucleoside reverse transcriptase inhibitor-sparing regimen for salvage therapy in HIV-infected patients with triple-class experience. 2015 78

Since the first reports between the association of Human Immunodeficiency Virus (HIV) infection and neoplasia, there has been a dramatic change in the incidence and epidemiology of AIDS-related malignancies. Kaposi sarcoma (KS), non-Hodgkin's lymphomas (NHL), and cervical cancer are classified by the Centers for Disease Control and Prevention (CDC) as AIDS-defining malignancies. However, since the availability of highly active combination antiretroviral therapy (cART), especially protease inhibitors, there has been a steady increase in non- AIDS defining malignancies, such as Hodgkin's lymphoma (HL), lung cancer, hepatocellular cancer, anal cancer and others and a decline in AIDS-defining neoplasias. Although the emergence of non-AIDS defining cancers could be a result of longer life expectancy and due to a better control of HIV, toxic habits and co-infection with other viruses such as hepatitis B, hepatitis C and human papilloma virus (HPV) could play an important role. The interactions of cART and incomplete immune reconstitution could be other factors explaining the increase in non-AIDS defining cancers. These emerging non-AIDS defining malignancies present a new challenge in the care of patients with HIV infection, and require optimal treatment protocols that take into consideration the interaction between cART and systemic chemotherapy. We review the current status of AIDS-related malignancies, its pathophysiology, epidemiology and management with emphasis in the changing patterns of presentation.
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PMID:AIDS-related malignancies: revisited. 2022 38


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