Comparison of perianal diseases in HIV-positive patients during periods before and after protease inhibitors use: what changed in the 21st century.
OBJECTIVE
Highly active antiretroviral therapy has enabled better control over HIV infection. Thus, the immunologic status of such patients has been improving and we believe that changes in their perianal diseases also have been occurring. This study was designed to compare anorectal disease incidence among HIV-positive patients attended in two eras: prehighly active antiretroviral therapy and highly active antiretroviral therapy.


METHODS
We examined 5,660 HIV-positive patients with anorectal diseases, divided into two groups: 1,860 treated during 1989 to 1995 (Group 1), and 3,800 during 1996 to 2005 (Group 2).


RESULTS
In Group 1, the most common diseases were condylomas (24.7 percent), ulcers (21.8 percent), and anal fistulas (19.7 percent). Tumors occurred in 2.5 percent, with Kaposi's sarcoma in 51.1 percent, and squamous-cell carcinoma in 27.6 percent. In Group 2, the most common anorectal lesions were condylomas (75.6 percent), ulcers (17 percent), and fistulas (12.1 percent). The tumor incidence was 1.8 percent, with squamous-cell carcinoma in 59.4 percent and Kaposi's sarcoma in 23.2 percent. Changes in incidence were statistically significant for the increase in condylomas and fissures, and for the decrease in ulcers, fistulas, and Kaposi's sarcoma among Group 2 patients.


CONCLUSIONS
Anorectal disease incidences have changed in the highly active anti-retroviral therapy era.
Nadal
Sidney Roberto
SR
Emilio Ribas Infectious Diseases Institute, Sao Paulo, Brazil. srnadal@terra.com.br
Manzione
Carmen Ruth
CR
Horta
Sergio Henrique Couto
SH
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D006679:HIV Seropositivity; D006801:Humans; D015994:Incidence; D008297:Male; D011480:Protease Inhibitors / Q000627:therapeutic use*; D012002:Rectal Diseases / Q000175:diagnosis / Q000453:epidemiology*
D011480:Protease Inhibitors