Review Articles On Anal Canal Lesions In HIV-Positive Patients
Epidermoid
carcinoma of the anal canal is uncommon. The incidence of this disease has increased in HIV-positive men who have sex with men and the disease process is different from in HIV-negative patients. Modern therapy of HIV with
highly active antiretroviral therapy (HAART) has improved the overall survival of HIV patients and allowed effective therapy for those who develop epidermoid
carcinoma of the anal canal. n the early years of the
AIDS epidemic, many patients died of overwhelming
infection due to their immunocompromised status. Only after the development of
highly active antiretroviral therapy (HAART), in the mid-1990s, did HIV-positive patients begin to have longer life expectancies. In many cases, HIV
infection became a chronic disease and new clinical
phenomena began to become apparent. As patients lived longer with reconstituted immune systems, they began to manifest new phenotypes of HIV infection. HPV is a DNA virus, often sexually transmitted, that causes anal SCC. There are many viral subtypes; HPV 16 and 18 have the highest malignant potential.5 Understanding of anal
carcinogenesis is based on cervical carcinogenesis, which is an identified pathway of HPV infection, persistence of infection, development of dysplasia, and progression to invasive carcinoma.6 HPV-infected anal mucosal
cells undergo this temporal progression, with the stages of dysplasia graded as anal intraepithelial neoplasia (AIN). Reverse steps in this pathway can include clearance of HPV
infection and regression of dysplasia.
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