Prevalência de lesões precursoras do câncer anal em indivíduos HIV positivos, atendidos na Fundaçào de Medicina Tropical do Amazonas, experiência inicial em Manaus

Gimenez, Felicidad Santos; Silva, Ivan Tramujas da Costa e; Guimarães, Adriana Gonçalves Daumas Pinheiro; Ferreira, Luíz Carlos de Lima; Araújo, José de Ribamar; Rocha, Renata Pina; Atala, Larissa de Souza; Avi, Sabrina Veloso; Talhari, Sinésio

doi:10.1590/s0101-98802008000100010

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…These results are similar to other findings in the literature for the prevalence of ASIL, where LSIL ranges from 35.7% (20) to 42% (38) , while HSIL from 7.1% (18) to 26% (21) .…”

Section: Asil Prevalencesupporting

confidence: 92%

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The value of high-resolution anoscopy in the diagnosis of anal cancer precursor lesions in hiv-positive patients

Gimenez

Costa-e-Silva

Daumas

et al. 2011

Arq. Gastroenterol.

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-Context -Anal cancer, although a still rare disease, is being observed in ascending rates among some population segments known to be at risk for the development of the disease. Human papillomavirus (HPV) infection, immunodepression and anal intercourse are some factors associated with the development of the malignancy. Its similarities to cervical cancer have led to many studies aiming to establish guidelines for detecting and treating precursor lesions of anal cancer, with the goal of prevention. Highresolution anoscopy is routinely used for the diagnosis of anal cancer precursor lesions in many centers but the medical literature is still deficient concerning the role of this diagnostic modality. Objectives -To evaluate diagnostic validation and precision measures of high-resolution anoscopy in comparison to histopathological results of anal biopsies performed in HIV-positive patients treated at the Tropical Medicine Foundation of Amazonas, AM, Brazil. To observe any possible association between some risk factors for the development of anal cancer and the presence of anal squamous intraepithelial lesions. Methods -A hundred and twenty-eight HIV-positive patients were submitted to anal canal cytological sampling for the detection of HPV infection by a PCR based method. High-resolution anoscopy was then performed after topical application of acetic acid 3% in the anal canal for 2 minutes. Eventual acetowhite lesions that were detected were recorded in respect to location, and classified by their tinctorial pattern, distribution aspect, relief, surface and vascular pattern. Biopsies of acetowhite lesions were performed under local anesthesia and the specimens sent to histopathological analysis. The patients were interviewed for the presence of anal cancer risk factors. Results -The prevalences of anal HPV infection and of anal squamous intraepithelial lesions in the studied population were, respectively, 79% and 39.1%. High-resolution anoscopy showed sensibility of 90%, specificity of 19.23%, positive predictive value of 41.67%, negative predictive value of 75%, and a kappa coefficient of 0.076. From the analyzed lesions, high-grade squamous intraepithelial lesions was more frequently observed in association to dense (68%), flat (61%), smooth (61%), non-papillary (83%) and normal vascular pattern (70%) acetowhite lesions, while low-grade squamous intraepithelial lesions tended to be associated to dense (66%), flat-raised or raised (68%), granular (59%), non-papillary (62%) and normal vascular pattern (53%) acetowhite lesions. No statistical significance was observed as to the association of epidemiological characteristics and of most of the investigated anal cancer risk factors and presence of acetowhite lesions or anal squamous intraepithelial lesions. However, anal receptive sex and anal HPV infection were significantly associated to anal squamous intraepithelial lesions (P = 0.0493 and P = 0.006, respectively). Conclusion -High-resolution anoscopy demonstrated to be a sensitive, but not specific test ...

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“…These results are similar to other findings in the literature for the prevalence of ASIL, where LSIL ranges from 35.7% (20) to 42% (38) , while HSIL from 7.1% (18) to 26% (21) .…”

Section: Asil Prevalencesupporting

confidence: 92%

“…Fox et al (13) reported ASIL was found in HIV-positive MSM in a prevalence of 26% and 36% in two cohort studies undertaken at the USA mainly before the advent of HAART. Gimenez et al (18) have previously reported a prevalence of ASIL in HIV-positive MSM of 42% (P = 0.03).…”

Section: Intraepithelial Lesionsmentioning

confidence: 92%

The value of high-resolution anoscopy in the diagnosis of anal cancer precursor lesions in hiv-positive patients

Gimenez

Costa-e-Silva

Daumas

et al. 2011

Arq. Gastroenterol.

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“…(30%) and was greater than that reported by others 4,22,23 , including a study at the same institution with a reported 7.1% II/III AIN and…”

contrasting

confidence: 51%

“…, Gimenez et al 22 and less than 81% among HIV-positive MSM described by Palefsky et al 23 and Manzione et al 24 . The authors are unanimous in asserting the importance of the presence of HIV infection in the occurrence of AIN 3,4,18,21 .…”

mentioning

confidence: 97%

Morphometric analysis of dendritic cells from anal mucosa of HIV-positive patients and the relation to intraepithelial lesions and cancer seen at a tertiary health institution in Brazil

Guimarães

Silva²,

Costa

et al. 2011

Acta Cir. Bras.

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1Análise morfométrica das células dendríticas da mucosa anal de pacientes HIV-positivos e relação com as lesões intraepiteliais e o câncer numa instituição de saúde terciária no Brasil -Acta Cirúrgica Brasileira -Vol. 26 (6) 2011weakening the DC for its major role in immune surveillance. Notoriously in patients with severe anal intraepithelial neoplasia, the density of CD1a+ epithelial dendritic cells was influenced by the viral load of HIV-1. Our study describes for the first time the density of subepithelial DC-SIGN+ dendritic cells in patients with anal severe anal intraepithelial neoplasia and points to the possibility that a specific therapy for HIV induces the recovery of the density of epithelial DC.Keywords: Dendritic Cells. HIV. Anus Diseases. Neoplasms. RESUMO OBJETIVO:Quantificar morfometricamente as células dendríticas DC CD1a+ e DC DC-SIGN+ em pacientes HIV positivos portadores de neoplasia escamosa intraepitelial anal e avaliar os efeitos da infecção pelo HIV, da terapia antirretroviral e da infecção pelo HPV sobre as células dendríticas epiteliais e subepiteliais. MÉTODOS:Um estudo prospectivo foi realizado para analisar morfometricamente o volume relativo das células dendríticas e as relações entre neoplasia intraepitelial anal e o câncer em pacientes HIV positivos da Fundação de Medicina Tropical do Amazonas, Brasil.Todos os pacientes foram submetidos a biópsia da mucosa retal para realizar uma análise clássica histopatológica e imunohistoquímica utilizando anticorpos contra anti-CD1a e anti-DC-SIGN, para a quantificação morfométrica das células dendríticas. RESULTADOS: CONCLUSÕES:Nossos dados confirmam a potencialização da ação sinérgica representada pela coinfecção HIV-HPV sobre o epitélio anal, fragilizando as DC em sua função primordial de vigilância imune. Notoriamente nos pacientes com neoplasia intraepithelial anal grave, a densidade das DC CD1a+ epiteliais sofreu influência da carga viral do HIV-1. Nosso estudo descreveu pela primeira vez a densidade das DC subepiteliais DC-SIGN+ em pacientes com neoplasia intraepithelial anal severa e apontamos para a possibilidade de que a terapia específica para o HIV induza a recuperação da densidade das DC epiteliais.

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Anal cancer: an essay on etiology, risk conditions, vulnerability, and care of carriers

Santos

Mendes²,

Ferla

2022

J Bras Doenças Sex Transm

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Introduction: The incidence of anal cancer is influenced by individual factors and socially determined conditions of vulnerability. In Brazil, it has increased in recent decades. A probable explanation for the growing incidence is the low coverage of screening and prevention programs. Objective: The aim of this study was to reflect on risk factors, the need for early diagnosis, and care of people with anal cancer and to associate social vulnerability in the understanding of illness and care in the Unified Health System (SUS). Methods: This is a systematic literature review with consultations carried out in open electronic databases: SciELO, Digital Library of Theses and Dissertations, and CAPES Publications Portal. The descriptors used were “anal cancer,” “anal cytology,” “anal cancer precursor lesions,” “primary prevention,” “integrality in health,” and “public health policies.” Results: Ensuring access to services is a common guideline in the literature. Based on the recovered references, two axes of analysis were built: in the first, ideas to reflect on care with collective health approaches were systematized, mainly on the etiology, biological risk factors, and conditions of vulnerability for cancer development to which the subjects are exposed. In the second, ideas to propose care technologies are put forward, with evidence from similar protocols and policies, especially the “Cervical Cancer Control Program,” which deals with a pathology with cytohistological and etiological similarities, risk factors, diagnostic techniques, and skilled health professionals. Conclusion: The reviewed sources point to the possibility of incorporating, as a SUS policy, large-scale actions of prevention, screening, and early diagnosis, to qualify and expand the initiatives of promotion and care. The professional cytotechnologist can be a decisive factor in the implementation of the care policy, expanding assistance to the population and qualifying the services.

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Prevalência de lesões precursoras do câncer anal em indivíduos HIV positivos, atendidos na Fundaçào de Medicina Tropical do Amazonas, experiência inicial em Manaus

Cited by 3 publications

References 19 publications

The value of high-resolution anoscopy in the diagnosis of anal cancer precursor lesions in hiv-positive patients

The value of high-resolution anoscopy in the diagnosis of anal cancer precursor lesions in hiv-positive patients

Morphometric analysis of dendritic cells from anal mucosa of HIV-positive patients and the relation to intraepithelial lesions and cancer seen at a tertiary health institution in Brazil

Anal cancer: an essay on etiology, risk conditions, vulnerability, and care of carriers

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