Módulo 2 – Curso pós-graduado – VIH e Envelhecimento

Non-AIDS Defining Cancers Among HIV Infected People

Clinical Management of non-AIDS defining cancers

Autor: Prof. Doutor Vicente Estrada, MD PhD (Hospital Clínico San Carlos, Madrid, Spain)

Anal cancer

Anal cancer has become one of the most common NADC. Some risk factors for anal cancer among HIV-infected individuals have been already identified:

  • Smoking
  • Unprotected receptive anal intercourse
  • MSM
  • High number of sexual partners
  • High-risk HPV types (16 and 18) and multiple serotypes
  • Low CD4+ cell count

It seems that this decade of ART has an influence on the incidence of these problems, thus suggesting that ART exerts a benefic effect on the incidence of new anal neoplasias8. The screening strategies for anal cancer are well described but the impact on mortality still requires more evidence9. Anal cytology screening is recommended for HIV-infected patients. If a patient has a negative cytology, a new cytology should be conducted in two years. If there is a suspected lesion in the cytology, a HRA with biopsy should be performed, and if there is a low-grade lesion, a follow up should be performed every six months.

The treatment of anal cancer depends on the tumor stage. Surgery and radiotherapy are indicated in the first phases (until stage 3) while chemotherapy is indicated in all the stages10. Regarding the risk of post-surgery infections in HIV-infected patients, it is similar to the risk of the general population, and only patients with very severe immunodepression might be at risk.

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