Comparative study of the effect of antiretroviral therapy on benign lymphoepithelial cyst of parotid glands and ranulas in HIV-positive patients

Abstract

Objective. T h i s s tu dy ' s ai m w as to a s s e ss th e ef f e c t of h i gh l y a c ti v e an ti r e tr ov i r al d r u g s (HAART) on benign lymphoepithelial cysts (BLEC) of the parotid and ranulas.Study design. The records of 10 HIV-positive patients who presented with BLEC were reviewed, and 14 HIV-positive patients who presented with ranulas were prospectively enrolled. Patients in 2 both groups received the same combination of HAART and were clinically evaluated for the first three months. Patients with ranulas were followed up for an additional three months. A clinical reduction in the size of the lesions was considered to be a positive outcome.Results. All parotid glands with BLEC resolved within three months. No positive results were observed in ranulas during the first three months. However, some of the ranulas displayed a positive result after the initial three months of HAART. Conclusion.In contrast to BLEC, ranulas in HIV-positive patients seem to present a mixed and delayed response to HAART.Numerous publications report about HIV-related salivary gland disease (HIV-SGD). HIV-related enlargement of the parotid salivary gland, particularly benign lymphoepithelial cysts (BLEC), remains the most reported form of HIV-SGD. [1][2][3][4][5][6] Other salivary glands are affected as well 1 .However, little has been reported about ranulas as being part of HIV-related salivary gland Currently, the generally accepted standard mode of treatment for ranulas is surgical removal of the offending ipsilateral salivary gland either with or without the attached cystic lesion. [13][14][15] However, this radical surgical approach might face limitations in the current clinical presentations of some cases of ranulas in HIV-positive patients. Current cases seem to include more cases of plunging and bilateral ranulas (Fig. 1). More importantly, there are reported cases of BLEC co-existing with ranulas in the same subject and in multiple sites (Fig. 1A). This c l i n i c a l p r e s e n t a t i o n o f b o t h p a t h o l o g i e s i s o f g r e a t e t i o l o g i c a l i m p o r t a n c e a n d p r e s e n t s therapeutic implications in the context of HIV-SGD. The quest for a less invasive modality of 4 treatment for ranulas in HIV-positive patients might, therefore, become a greater challenge. To date, there is no evidence-based proof of treatment for ranulas with HAART. 12 The welldocumented benefit of HAART for BLEC in HIV-positive patients has led these authors to hypothesize that the very same drugs may positively affect ranulas in the context of HIV-SGD. A comparative approach has not been performed before.The aim of this study is, therefore, to assess how ranulas in HIV-positive patients respond to HAART, and compare the results with those of BLEC in parotid salivary glands in the context of HIV-SGD. Furthermore, a secondary objective is to define the time-frame within which to assess the effectiveness of the therapy in both groups. PATIENTS AND METHODSThis was a clinical study with both retrospective an...

Lymphoid Proliferations Associated With Human Immunodeficiency Virus Infection

“…53,54 In many patients, treatment with HAART results in smaller lesions or their complete resolution. 58 MULTICENTRIC CASTLEMAN DISEASE Early in the AIDS epidemic, young, homosexual men and other people with HIV, many of whom had systemic symptoms and lymphadenopathy, had lymph node biopsies that showed features of Castleman disease. Furthermore, like HIV À patients with MCD, many of the HIV þ patients also had or developed Kaposi sarcoma.…”

Benign lymphoepithelial cysts of the parotid: long-term surgical results

“…BLEC of the parotid gland is the most common salivary gland pathology in HIV 1,2. BLEC has two hypothesized etiologic mechanisms.…”

“…BLEC is nearly diagnostic for HIV 1,2. Physical examination will show obvious fluctuant cystic facial deformity.…”

“…Previous treatments for BLEC have included repeated fine-needle aspiration and drainage, surgery, radiotherapy, sclerotherapy, and conservative therapy with institution of highly active antiretroviral therapy (HAART) medications 2–6,10–22Table 1 summarizes the advantages and disadvantages, duration of procedures, and the cost of treatment for BLEC.…”

“…Instituting HAART for BLEC has been shown to be effective in decreasing the size of the lesions 2,7. HAART treats systemic HIV by inhibiting retroviral transcription and viral replication.…”