Epstein-Barr Viral Load is Associated to Response in AIDS-Related Lymphomas.

AIDS-related lymphoma (ARL) development is associated to immunodeficiency state with proliferation of B-cells driven by HIV itself and EBV infection. However, Epstein-Barr DNA is not detected in malignant cells of all ARL subtypes. A prospective and controlled study to analyze EBV viral load (VL) in plasma and peripheral blood mononuclear cells (PBMC) of ARL patients was performed to analyze if Epstein-Barr VL could be related to response in these patients. Fifteen patients with ARL were included in this study with measurement of EBV VL at three different periods of time: at lymphoma diagnosis, upon completion of chemotherapy, and 3 months after. Two control groups composed by HIV-negative and HIV-positive patients were also evaluated for EBV VL comparison. In situ hybridization for EBER was performed on diagnostic samples of all ARL patients. Median EBV VL in PBMC and plasma had a significant decrease (p = 0.022 and p = 0.003, respectively) after ARL treatment. EBER was positive in 7 (46.7 %) cases. Median EBV VL in PBMC before lymphoma treatment in patients positive for EBER was significantly higher compared to EBER negative cases (p = 0.041). Reduction of EBV viral load during treatment of lymphoma could be predictive of response. EBER expression was associated to advanced stages of disease and worse immune status. Our study suggests that measurement of EBV VL during ARL treatment could be used as a marker for response, but further studies are needed to validate this association.

Local control of human papillomavirus infection after anal condylomata acuminata eradication.

OBJECTIVE: To verify whether the eradication of anal condylomata acuminata was effective for local control of HPV infection using anal colposcopy and anal brush cytology. METHODS: We evaluated 147 patients treated for anal margin and/or anal canal condyloma, with 108 HIV-positive and 39 HIV-negative individuals. The average age for males was 40 years for HIV-positive and 27.5 for HIV-negative. In females, the mean age was 37.5 years for HIV-positive and 31.5 for HIV-negative. RESULTS: Twenty-four patients (16.3%) had normal cytology and anal colposcopy, 16 (10.9%) normal cytology and altered anal colposcopy, 52 (35.4%) normal anal colposcopy and altered cytology, and 55 (37.4%) had altered cytology and anal colposcopy. CONCLUSION: the eradication of clinical lesions failed to locally control HPV infection.

Local control of human papillomavirus infection after anal condylomata acuminata eradication / Controle local da infecção perianal pelo papilomavirus humano após a erradicação dos condilomas acuminados

OBJECTIVE: To verify whether the eradication of anal condylomata acuminata was effective for local control of HPV infection using anal colposcopy and anal brush cytology. METHODS: We evaluated 147 patients treated for anal margin and/or anal canal condyloma, with 108 HIV-positive and 39 HIV-negative individuals. The average age for males was 40 years for HIV-positive and 27.5 for HIV-negative. In females, the mean age was 37.5 years for HIV-positive and 31.5 for HIV-negative. RESULTS: Twenty-four patients (16.3%) had normal cytology and anal colposcopy, 16 (10.9%) normal cytology and altered anal colposcopy, 52 (35.4%) normal anal colposcopy and altered cytology, and 55 (37.4%) had altered cytology and anal colposcopy. CONCLUSION: the eradication of clinical lesions failed to locally control HPV infection. .

OBJETIVO: verificar se a erradicação dos condilomas acuminados perianais foi efetiva no controle local da infecção pelo HPV, utilizando a colposcopia anal e a citologia anal com escova. MÉTODOS: avaliamos 147 pacientes tratados de condiloma da margem e/ou canal anal, sendo 108 HIV-positivos e 39 HIV-negativos. A média etária no sexo masculino foi 40 anos para os HIV-positivos e 27,5 anos para os HIV-negativos. No sexo feminino, a média etária foi 37,5 anos para os HIV positivos e 31,5 anos HIV-negativos. RESULTADOS: vinte e quatro pacientes (16,3%) apresentavam citologia e colposcopia normais, 16 (10,9%) citologia normal e colposcopia alterada, 52 (35,4%) citologia alterada e colposcopia normal e 55 (37,4%) citologia e colposcopia alteradas. CONCLUSÃO: a erradicação das lesões clínicas não controlou localmente a infecção pelo HPV. .

Frequência de alterações citológicas anais em pacientes com citologia cervical normal / Frequency of anal cytological abnormalities in patients with normal cervical cytology

Contexto e objetivo: O câncer anal corresponde a 4% de todas as neoplasias malignas do trato digestivo baixo.A incidência deste tipo de câncer e de suas respectivas lesões precursoras aumentou nos Estados Unidos, Europa eBrasil. A lesão intraepitelial escamosa anal de alto grau (LIEAG anal) é considerada provável precursora do tumor analinvasivo. Há alguma evidência de ligação entre o câncer anal e o câncer genital. O objetivo do presente estudo foiestimar a prevalência de alterações citológicas da mucosa anal em mulheres com citologia cervical positiva.Tipo de estudo e local: Corte transversal, realizado no Instituto de Infectologia Emílio Ribas.Métodos: Foram colhidas amostras para citologia cervical e anal de 104 mulheres (todas com lesões intraepiteliaisde baixo ou alto graus). Em um período de até um mês do resultado da primeira coleta citológica, foi realizada novacoleta cervical e duas amostras de esfregaço do canal anal. Todas as amostras foram obtidas com escova de coletacitológica cytobrush. As pacientes foram questionadas quanto à prática de intercurso anal. Os esfregaços citológicosforam classificados segundo a classificação de Bethesda 2001.Resultados: Das 104 pacientes com citologia cervical anormal, 51 (49%) apresentaram LIEAG cervical, 48 (46,2%)LIEBG cervical, 5 (4,8%) atipia escamosa de significado indeterminado (ASC-US) cervical. Destas 104 pacientes, 75(72%) também apresentaram citologia anal anormal e 29 (28%) esfregaços anais normais ou inflamatórios. Não houvediferença estatística entre os grupos com HSIL e LSIL cervicais, no que tange à propensão a apresentar citologia analanormal (P > 0,05). Não houve diferença estatística significante entre os grupos quanto à propensão da presença dealterações citológicas anormais anais nas pacientes que praticavam intercurso anal (P > 0,05).Discussão: Nossos resultados sugerem que a transmissão do vírus HPV da mucosa anal para cervical ou vice-versa sejadecorrente de questões anatômicas, como proximidade do orifício anal e hábitos de higiene pessoal, e não de relaçõessexuais anais.Conclusão: Houve prevalência de 72% de citologia anal anormal nas pacientes com citologia cervical positiva, porém,é necessária realização de mais estudos para se estabelecer se a mucosa anal é realmente um reservatório para oHPV, o que por si só já é epidemiologicamente importante para futuros programas de erradicação de lesões cervicaisrelacionadas ao HPV.

Evaluation of Langerhans cells counts comparing HIV-positive and negative anal squamous cell-carcinoma patients.

PURPOSE: To investigate the differences in Langerhans cells (LCs) populations between HIV-positive and negative anal squamous cell carcinomas patients. METHODS: Twenty five patients (14 HIV-positive and 11 HIV-negative) were evaluated. Paraffin-block transversal thin sections from biopsies of anal squamous cell carcinomas (ASCC) were stained using the anti-CD1A antibody that identifies activated LCs. LCs counts were performed using histometry at 20 different sites, at baseline in the ASCC cases. These were then compared with LCs counts in anal canal specimens from HIV-negative and positive patients without ASCC (controls groups). RESULTS: In patients with ASCC, the LC count was greater among HIV-negative individuals than among HIV-positive individuals (p<0.05). The LC count was greater in the control HIV-negative group than in HIV-positive patients with ASCC (p<0.05). CONCLUSION: There was a lower amount of activated LCs in HIV-positive patients with anal squamous cell carcinomas than in HIV-negative patients, thereby suggesting worsening of the immune response.

Evaluation of Langerhans cells counts comparing HIV-positive and negative anal squamous cell-carcinoma patients / Avaliação das células de Langerhans no carcinoma espinocelular do canal anal em pacientes HIV-positivo e negativo

PURPOSE: To investigate the differences in Langerhans cells (LCs) populations between HIV-positive and negative anal squamous cell carcinomas patients. METHODS: Twenty five patients (14 HIV-positive and 11 HIV-negative) were evaluated. Paraffin-block transversal thin sections from biopsies of anal squamous cell carcinomas (ASCC) were stained using the anti-CD1A antibody that identifies activated LCs. LCs counts were performed using histometry at 20 different sites, at baseline in the ASCC cases. These were then compared with LCs counts in anal canal specimens from HIV-negative and positive patients without ASCC (controls groups). RESULTS: In patients with ASCC, the LC count was greater among HIV-negative individuals than among HIV-positive individuals (p<0.05). The LC count was greater in the control HIV-negative group than in HIV-positive patients with ASCC (p<0.05). CONCLUSION: There was a lower amount of activated LCs in HIV-positive patients with anal squamous cell carcinomas than in HIV-negative patients, thereby suggesting worsening of the immune response.

OBJETIVO: Comparar a quantidade de células de Langerhans (CL) em pacientes portadores do carcinoma espinocelular (CEC) do canal anal HIV-positivo e negativo. MÉTODOS: Avaliamos 25 pacientes, sendo 11 HIV-negativo e 14 HIV-positivo portadores do CEC do canal anal. Realizamos estudo com a coloração imunoistoquímica anti-CD1A para avaliar as CL ativadas. Utilizamos as lâminas coradas e pelo método da histometria contamos em 20 campos diferentes as células coradas na camada basal da lâmina própria, onde era evidente a disseminação tumoral. Realizamos dois grupos controles compostos por pacientes submetidos à biopsia anal sem neoplasia (sete pacientes HIV-negativo e quatro HIV-positivo). Comparamos as contagens de CL. RESULTADOS: A quantidade de CL foi superior nos pacientes portadores do CEC do canal anal soronegativo para o HIV, em relação aos soropositivos (p<0,05). A quantidade de CL foi superior no grupo controle HIV-negativo em relação ao grupo composto por pacientes soropositivos portadores do CEC do canal anal (p<0,05). CONCLUSÃO: Houve aumento das células de Langerhans ativadas na área peritumoral dos pacientes soropositivos para o HIV, o que sugere diminuição da resposta imune local.

FOXP3(+) regulatory and TIA-1(+) cytotoxic T lymphocytes in HIV-associated Hodgkin lymphoma.

Human immunodeficiency virus (HIV) infects CD4(+) lymphocytes, leading to a development of malignant lymphomas, such as HIV-associated Hodgkin Lymphoma (HIV-HL). This study aimed to assess the differences in cellular composition of the inflammatory reactive background of HIV-HLs. We examined infiltrating T lymphocytes, specifically regulatory T cells, cytotoxic cells, Epstein-Barr virus (EBV) related antigens and HIV-receptor CCR5. In all HIV-HL cases, Hodgkin and Reed-Sternberg (HRS) cells showed EBER1 expression, LMP-1 staining positivity and EBNA-2 staining negativity, except for one case which showed LMP-1 staining negativity. Our histological findings indicate the percentage of CD8(+) , TIA-1(+) lymphocytes was significantly higher in HIV-HL than in non-HIV-HL cases (P < 0.05). On the other hand, the percentage of CD4(+) , FOXP3(+) lymphocytes was significantly lower in HIV-HL than in non-HIV-HL cases (P < 0.05) but present. The percentage of CCR5(+) lymphocytes was significantly lower in HIV-HL than in non-HIV-HL cases (P < 0.05). Usually, CD4(+) and CCR5(+) lymphocytes are reported to be rarely detected in HIV-associated non-Hodgkin lymphomas, but the presence of CD4(+) and/or FOXP3(+) lymphocytes may be implicated in the pathogenesis of HL. In addition, although additional CD8(+) lymphocytes are probably not EBV-LMP specific cytotoxic T-cells, these lymphocytes may also well be involved in the pathogenesis of HIV-HL.

Evolução dos doentes com citologia oncótica alterada e colposcopia anal normal / Outcome of patients with anal oncotic cytology alterations and normal anal colposcopy

A citologia anal vem sendo usada para rastreamento do carcinoma anal e suas lesões precursoras nas populações de risco. Quando o raspado do canal anal mostra alterações citológicas está indicada o exame com colposcópio e ácido acético para identificar e realizar biópsia para confirmar o achado. Poucos estudos mostram o seguimento dos doentes tratados de condilomas acuminados perianais. Temos usado os métodos em associação e encontrado lesões subclínicas em metade dos doentes, cujo exame proctológico não revelava doença HPV induzida. Essas lesões são tratadas com tópicos. Entretanto, algumas citologias estavam alteradas e a colposcopia anal não revelou doença HPV induzida. O objetivo deste estudo foi observar o comportamento dessas lesões no seguimento semestral, durante 12 meses, e avaliar se a periodicidade da reavaliação foi suficiente para evitar o aparecimento das lesões de alto grau ou superior. Encontramos 58 (21 por cento) entre 273 doentes nessas condições. As reavaliações de 22 deles após um ano mostraram que as colposcopias permaneceram normais em 17 (74 por cento), sendo que em cinco (22 por cento) a citologia voltou aos padrões normais e 12 (52 por cento) persistiram com alterações. Os outros seis (26 por cento) desenvolveram lesões clínicas ou subclínicas provocadas pelo HPV. As contagens de linfócitos T CD4 dos doentes HIV-positivos foram inferiores nos doentes cujas lesões progrediram. Os resultados permitiram concluir que as alterações podem progredir ou regredir neste grupo distinto de doentes, sendo relacionada à imunidade, e que o intervalo de seis meses é suficiente para cada reavaliação.

Anal cytology has been used for screening the anal carcinoma and its precursors in risk populations. When anal canal smear shows cytological alterations, examination with colposcope and acetic acid is indicated to identify and perform biopsy to confirm the finding. Few studies show the follow-up of patients treated with anal HPV induced lesions. We are using both methods in association and subclinical lesions have been found in 50 percent of patients, whose proctological examinations are free from HPV lesions. However, some smears have cytological alterations, despite anal colposcopy being normal. The aim of this study was to observe these lesions' behavior in a six-month follow-up, during a year, and to assess whether this periodicity of re-evaluations was enough to avoid high grade or superior lesions. We have found 58 (21 percent) among 273 patients with these parameters. One year re-evaluations of 22 of the patients showed that anal colposcopies remained normal in 17 (74 percent). In five (22 percent), the cytology returned to normality and in 12 (52 percent), the same abnormality was seen. The other six patients (26 percent) developed clinical or subclinical HPV induced lesions. T CD4+ lymphocytes counts of HIV-positive patients were inferior in those whose lesions progressed. These results permitted us to conclude that cytological alterations can progress or clear in these patients, and they have close relationship with the immunity, and the six-month interval is enough to each re-evaluation.

Aspectos tomográficos da tuberculose pulmonar em pacientes adultos com AIDS / Computed tomography findings of pulmonary tuberculosis in adult AIDS patients

OBJETIVO: Este trabalho tem como finalidade descrever os achados tomográficos da tuberculose pulmonar em pacientes adultos com AIDS atendidos no serviço de radiologia de um hospital de referência em doenças infecciosas, procurar associações desses achados e a contagem de CD4. MATERIAIS E MÉTODOS: Foram estudados 45 pacientes por meio de tomografia computadorizada de tórax durante quatro anos. RESULTADOS: Foram encontrados linfonodomegalia mediastinal e/ou hilar em 31 (68,8 por cento) dos casos, derrame pleural em 29 (64,4 por cento), nódulos centrolobulares de distribuição segmentar em 26 (57,7 por cento), consolidação em 24 (53,3 por cento), confluência de micronódulos em 17 (37,7 por cento), nódulos mal definidos com distribuição centrolobular em 16 (35,5 por cento), padrão de "árvore em brotamento" em 13 (28,9 por cento), espessamento de parede brônquica em 12 (26,6 por cento), cavidade de parede espessa em 10 (22,2 por cento), nódulos miliares em 9 (20 por cento) e bronquiectasias cilíndricas em 6 (13,3 por cento). Dos 45 pacientes, 35 (77,8 por cento) apresentaram CD4 < 200 cel/mm³ e 10 (22,2 por cento) apresentaram CD4 > 200 cel/mm³. CONCLUSÃO: Concluímos que neste estudo, diversamente do descrito na literatura, linfonodomegalia mediastinal e/ou hilar e consolidação foram significativamente mais frequentes em pacientes com CD4 > 200 cel/mm³. No entanto, linfonodos com centro hipodenso foram mais frequentemente observados em pacientes com severa imunodepressão, ou seja, CD4 < 200 cel/mm³.

OBJECTIVE: The present study is aimed at describing computed tomography findings pulmonary tuberculosis in adult AIDS patients assisted at a radiology unit of a reference infectious diseases hospital, in an attempt to establish the association between such findings and CD4 count. MATERIALS AND METHODS: Forty-five patients were evaluated by chest computed tomography over a four-year period. RESULTS: Mediastinal and/or hilar lymph node enlargement was found in 31 (68.8 percent) cases, pleural effusion in 29 (64.4 percent), centrilobular nodules with segmental distribution in 26 (57.7 percent), consolidation in 24 (53.3 percent), confluent micronodules in 17 (37.7 percent), poorly defined nodules with centrilobular distribution in 16 (35.5 percent), tree-in-bud pattern in 13 (28.9 percent), bronchial wall thickening in 12 (26.6 percent), thick-walled cavity in 10 (22.2 percent), miliary nodules in 9 (20 percent), and cylindrical bronchiectasis in 6 (13.3 percent). Among the 45 patients, 35 (77.8 percent) presented CD4 count < 200 cel/mm³ and 10 (22.2 percent) presented CD4 count > 200 cel/mm³. CONCLUSION: Differently from reports in the literature, the authors conclude that mediastinal and/or hilar lymph node enlargement and consolidation were significantly most frequent in patients with CD4 count > 200 cel/mm³. However, lymph nodes with hypodense center were most often observed in severely immunosuppressed patients with CD4 count < 200 cel/mm³.

A prognostic score for AIDS-related diffuse large B-cell lymphoma in Brazil.

The aim of this study was to evaluate a prognostic score for aids-related lymphoma (ARL). A retrospective study of 104 patients with ARL treated between January 1999 and December 2007 was conducted. Diffuse large B-cell lymphoma (DLBC) was the most observed histological type (79.8%). The median CD4 lymphocyte count at lymphoma diagnosis was 125 cells per microliter. Treatment response could be evaluated in 83 (79.8%) patients, and 38 (45.8%) reached complete remission (CR); overall response rate was 51.8% (95 CI = 38.5-65.1%). After a median follow-up of 48 months, the 4-year overall survival (OS) rate among all patients was 35.8%, with a median survival time of 9.7 months (95% CI = 5.5-13.9 months). The survival risk factors observed in multivariate analysis (previous AIDS and high-intermediate/high international prognostic index (IPI)) were combined to construct a risk score, which divided the whole patient population in three distinct groups as low, intermediate, and high risk. When this score was applied to DLBC patients, a clear distinction in response rates and in OS could be demonstrated. Median disease-free survival (DFS) for patients that achieved CR was not reached, and DFS in 4 years was 83.0%. Our results show that the reduced OS observed could be explained by poor immune status with advanced stage of disease seen in our population of HIV-positive patients. Further studies will be needed to clarify the role of different treatment approaches for ARL in the setting of marked immunosuppression and to identify a group of patients to whom intensive therapy could be performed with a curative intent.

Sensibilidade e especificidade da citologia anal com escova no diagnóstico das lesões clínicas provocadas pelo papilomavírus humano, comparando uma com duas coletas / Sensibility and specifity of anal cytology with cytobrush in the HPV induced clinical lesions diagnosis, comparing one to two smears

OBJETIVO: comparar os resultados da coleta única com duas amostras para avaliar se haverá melhora da sensibilidade e especificidade do exame. MÉTODO: Foram 112 doentes masculinos HIV-positivo com doença anal pregressa ou atual pelo Papilomavírus humano (HPV). As lesões HPV induzidas foram observadas em 58 deles. Colhemos material do canal anal utilizando duas escovas (cytobrush) Comparamos estatisticamente os resultados da primeira amostra com a soma das duas coletas. RESULTADOS: dos 58 doentes com lesões clínicas, a primeira amostra confirmou a doença em 40 (69 por cento) e a soma das duas coletas revelou lesões em 51 (88 por cento). Os resultados mostraram sensibilidade de 69 por cento com a primeira coleta e 88 por cento quando somadas as duas amostras. Essa diferença foi confirmada estatisticamente. A especificidade foi menor para as duas amostras, porém sem diferença estatística. CONCLUSÃO: Concluímos que a sensibilidade foi maior e a especificidade foi semelhante quando os resultados foram obtidos com a somação das duas amostras da citologia anal.

OBJECTIVE: The aim of this study was to know if two smears may have better sensibility and specificity than a unique smear for anal cytology. METHOD: There were 112 patients, males, HIV-positive, with current or previous anal HPV-induced lesions. Proctological examination revealed clinical disease in the anal canal of 58 of them. Smears were collect with cytobrushes. We compared results of the first smear to a sum of this with a second one. RESULTS: First smear was positive in 40 patients (69 percent), and with both smears this incidence reached 88 percent. Results showed sensibility of 69 percent to the unique smear, and 88 percent when both were summed. Statistics revealed significant difference. Specificity was higher when both smears were summed, but statistics showed no difference. CONCLUSION: We concluded sensibility of anal cytology was better and specificity was similar when results were obtained with a sum of two smears.

[How far into the anal canal should the brush be introduced for more efficient cytological evaluation?]. / Quanto a escova deve ser introduzida no canal anal para avaliação citológica mais eficaz?

OBJECTIVE: In literature, sensitivity of Pap smears ranges widely from 45 to 98%. Possibly this is because there is no standard for how far the brush should be introduced into the anal canal. The aim was to evaluate whether the sampling site has an influence on the results of anal Pap smears. DESIGN AND SETTING: This is a non-randomized, non-blinded, retrospective review carried out in the Proctology and Pathology Sectors, Emilio Ribas Infectious Diseases Institute. METHOD: We obtained specimens with brushes introduced 4 cm into the anal canal in 114 patients (Group A) and 2 cm in 94 patients (Group B), before anorectal examination. These brushes were rotated five or six times before being withdrawn and rubbed on a slide that underwent Pap testing using standard cytopathology laboratory equipment. All patients were HIV-infected. Statistical tests were used. RESULTS: In Group A, 39 patients had anal canal condylomas and the cytology was positive in 29 of them (74.3%). We also observed cytological alterations in 30 of 75 patients (40%) without clinical lesions in the anal canal. In Group B, there were 54 patients with condylomas and 13 of them (24.1%) were confirmed by cytology. In 40 patients with no clinical lesions, we observed that nine (22.5%) had cytological abnormalities Statistical analysis revealed that examination in Group A was more efficient. CONCLUSION. Specimens collected by inserting the brush deeper into the anal canal improved the efficiency of anal Pap smears.

Quanto a escova deve ser introduzida no canal anal para avaliação citológica mais eficaz? / How deep must the brush be introduced in the anal canal for a more effective cytological evaluation?

OBJETIVO: A sensibilidade da citologia anal varia amplamente na literatura, entre 45 por cento e 98 por cento, o que pode ocorrer devido à falta de padronização quanto à distância que a escova deve ser introduzida no canal anal. Desta forma, nosso objetivo foi investigar se o local de coleta influencia no resultado desse exame. MÉTODOS: Colhemos amostras com escova introduzida 4 cm no canal anal de 114 doentes (Grupo A) e 2 cm em outros 94 pacientes (Grupo B), antes do exame proctológico. Realizamos cinco rotações com a escova antes de retirá-la e a esfregar sobre lâmina de vidro, posteriormente submetida ao exame citopatológico padrão. Todos os doentes são HIV-positivo. Submetemos os resultados à avaliação estatística. RESULTADOS: No Grupo A, 39 doentes possuíam condilomas no canal anal e a citologia foi positiva em 29 deles (74,3 por cento). Também observamos alterações citológicas em 30 de 75 doentes (40 por cento) sem lesões clínicas no canal anal. No Grupo B, havia 54 doentes com condilomas no canal anal e em 13 (24,1 por cento) houve confirmação citológica. Em 40 outros, sem lesões clínicas pelo HPV, notamos que em nove (22,5 por cento) havia anormalidades citológicas. Os testes estatísticos revelaram que os exames realizados nos doentes do Grupo A foram mais eficientes. CONCLUSÃO: Os espécimes coletados com escovas inseridas mais profundamente no canal anal melhoraram a eficácia do exame.

OBJECTIVE: In literature, sensitivity of Pap smears ranges widely from 45 to 98 percent. Possibly this is because there is no standard for how far the brush should be introduced into the anal canal. The aim was to evaluate whether the sampling site has an influence on the results of anal Pap smears. Design and setting. This is a non-randomized, non-blinded, retrospective review carried out in the Proctology and Pathology Sectors, Emilio Ribas Infectious Diseases Institute. METHOD: We obtained specimens with brushes introduced 4 cm into the anal canal in 114 patients (Group A) and 2 cm in 94 patients (Group B), before anorectal examination. These brushes were rotated five or six times before being withdrawn and rubbed on a slide that underwent Pap testing using standard cytopathology laboratory equipment. All patients were HIV-infected. Statistical tests were used. RESULTS: In Group A, 39 patients had anal canal condylomas and the cytology was positive in 29 of them (74.3 percent). We also observed cytological alterations in 30 of 75 patients (40 percent) without clinical lesions in the anal canal. In Group B, there were 54 patients with condylomas and 13 of them (24.1 percent) were confirmed by cytology. In 40 patients with no clinical lesions, we observed that nine (22.5 percent) had cytological abnormalities Statistical analysis revealed that examination in Group A was more efficient. CONCLUSION. Specimens collected by inserting the brush deeper into the anal canal improved the efficiency of anal Pap smears.

[Outcome of treatment of anal squamous cell carcinoma and its precursor in HIV-infected patients]. / Resultados do tratamento do carcinoma espinocelular anal e do seu precursor em doentes HIV-positivos.

OBJECTIVE: Incidence of anal squamous cell carcinoma is increasing mainly among HIV-positive patients. Treatment consists of radiotherapy and chemotherapy, sometimes followed by tumor resection. The objective was to evaluate the follow-up of such patients to verify recurrences and evolution from HAIN to cancer. This is a report of cases treated at the "Instituto de Infectologia Emílio Ribas", Sao Paulo, Brazil. METHODS: We attended 45 HIV-positive patients between July 1996 and June 2006. Most were male (97.7%), with ages ranging from 23 to 55 years (mean: 38.5 years). Thirty patients had high grade anal intra-epithelial neoplasia (HAIN), treated with local resection, and 15 with anal canal invasive squamous cell carcinoma were first submitted to chemo radiation, while biopsies were obtained during follow-up. RESULTS: Patients with HAIN had recurrences in 16.7% of cases and remained cancer free for up to five years. Chemoradiation was not possible in five patients with invasive carcinoma (40%) because three had advanced AIDS and two refused treatment. Eight (88.8%) out of nine patients had complete response to chemoradiation and remained cancer free for a period from three to six years. Chemoradiation failed in the ninth patient: abdominal perineal resection was performed, and there was no recurrence over a five-year period. CONCLUSION: We concluded that HAIN can recur after local resection in HIV-positive patients but does not evolve to invasive carcinoma. Invasive cancer can be treated in the same way as in HIV seronegative persons, when clinical conditions permit.

Resultados do tratamento do carcinoma espinocelular anal e do seu precursor em doentes HIV-positivos / Outcome of treatment of anal squamous cell carcinoma and its precursor in HIV-infected patients

OBJETIVO: A incidência de carcinomas espinocelulares anais vem aumentando nos doentes HIV-positivos. O tratamento consiste de radio e/ou quimioterapia, eventualmente seguidos pela ressecção do tumor. O objetivo é avaliar o seguimento desses doentes para verificar as recidivas e a evolução do NIAA para câncer. Apresentação da casuística da Equipe Técnica de Proctologia do Instituto de Infectologia Emílio Ribas, de São Paulo. MÉTODOS: Acompanhamos 45 doentes HIV-positivos portadores de carcinoma espinocelular anal e seu precursor no período de 1996 a 2006. Eram 30 neoplasias intra-epiteliais anais de alto grau (NIAA), tratadas com ressecção local e 15 carcinomas invasores do canal anal. Nove das 15 lesões invasivas foram submetidas ao esquema de Nigro isolado ou associado à ressecção local, amputação abdominoperineal ou colostomia para derivação. RESULTADOS: No seguimento ambulatorial das NIAA tivemos recidiva em 16,7 por cento e não observamos evolução para carcinoma, num período mínimo de três anos. Entre os nove tumores submetidos ao esquema de Nigro, com ou sem operação complementar, cinco estão livres de tumor. Nenhum tratamento foi feito em cinco doentes. Em três, devido às péssimas condições clínicas, e em dois, pois recusaram tratamento. Outro teve diagnóstico na vigência de oclusão intestinal sendo submetido à colostomia de derivação. CONCLUSÃO: Concluímos que a NIAA pode reincidir após excisão local em doentes HIV-positivos, mas não evolui para carcinoma invasor e que os doentes de câncer anal invasor podem ser tratados da mesma maneira que a população soronegativa para o HIV desde que as condições clínicas o permitam.

OBJECTIVE: Incidence of anal squamous cell carcinoma is increasing mainly among HIV-positive patients. Treatment consists of radiotherapy and chemotherapy, sometimes followed by tumor resection. The objective was to evaluate the follow-up of such patients to verify recurrences and evolution from HAIN to cancer. This is a report of cases treated at the "Instituto de Infectologia Emílio Ribas", Sao Paulo, Brazil. METHODS: We attended 45 HIV-positive patients between July 1996 and June 2006. Most were male (97.7 percent), with ages ranging from 23 to 55 years (mean: 38.5 years). Thirty patients had high grade anal intra-epithelial neoplasia (HAIN), treated with local resection, and 15 with anal canal invasive squamous cell carcinoma were first submitted to chemo radiation, while biopsies were obtained during follow-up. RESULTS: Patients with HAIN had recurrences in 16.7 percent of cases and remained cancer free for up to five years. Chemoradiation was not possible in five patients with invasive carcinoma (40 percent) because three had advanced AIDS and two refused treatment. Eight (88.8 percent) out of nine patients had complete response to chemoradiation and remained cancer free for a period from three to six years. Chemoradiation failed in the ninth patient: abdominal perineal resection was performed, and there was no recurrence over a five-year period. CONCLUSION: We concluded that HAIN can recur after local resection in HIV-positive patients but does not evolve to invasive carcinoma. Invasive cancer can be treated in the same way as in HIV seronegative persons, when clinical conditions permit.