Evaluation of the HIV-infected patient with anorectal symptoms
- C Mel Wilcox, MD
C Mel Wilcox, MD
- Professor of Medicine
- University of Alabama at Birmingham
Anorectal symptoms in the HIV-infected patient may reflect significant pathology and accurate diagnosis is essential to direct patient management.
The general approach to the evaluation and management of the HIV-infected patient with anorectal symptoms will be discussed here. The treatment of the various disease entities is discussed elsewhere (see appropriate topic reviews).
ETIOLOGY OF ANORECTAL SYMPTOMS
Anorectal disorders are associated with significant morbidity and have been commonly described among HIV-infected patients, particularly men who have sex with men (MSM) [1-5]. Common findings in this population include perirectal abscesses, anal fistulae, nonspecific ulcerations, infectious proctitis, anal warts, anal intraepithelial neoplasia, and anal cancer [6-9]. Less common noninfectious etiologies include ulcerative colitis or Crohn's disease.
Anorectal carcinomas are more common in MSM than in the general population, and the risk increases dramatically among those who are HIV-infected. In a population-based survey that examined cancer rates among AIDS patients from 1980 to 2006, the incidence of AIDS-related cancers (eg, Kaposi’s sarcoma) declined sharply while the incidence of some non-AIDS defining cancer, such as anal cancer, increased . Furthermore, among persons with anal cancer, those with concomitant HIV infection were significantly younger at the time of diagnosis than those without HIV infection .
Risk factors for abnormal anal cytology in a study of 621 HIV-infected men and women included multiple human papillomavirus (HPV) types, immunosuppression (CD4 cell count <50 cells/mm3) and history of anal intercourse . (See "HIV infection and malignancy: Management considerations".)
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