ANORECTAL DISEASE IN HIV-INFECTED PATIENTS

PURPOSE: Anorectal diseases are common in human immunodeficiency virus -infected individuals. The aim of this prospective study was to assess the cause and clinical presentation of anorectal disease in this huma n immunodeficiency virus-infected population METHODS: A registry of al l human immunodeficiency virus-seropositive patients with anorectal co mplaints who were referred to and followed up in the colorectal surger y clinic at a county hospital was maintained, with all data collected prospectively. ALL patients underwent examination under anesthesia wit h random cultures and biopsies, along with specific sampling of any su spicious lesions. RESULTS: Data from 180 consecutive human immunodefic iency virus-seropositive patients with anorectal symptoms were analyze d. Mean age of the population was 34 years, with a male-to-female rati o of 14:1. This group comprised homosexual and bisexual males (55 perc ent), injection-drug users (15 percent), heterosexuals (12 percent), a nd others (18 percent). The average lag time from diagnosis of human i mmunodeficiency virus to anorectal symptoms was 48 months. The average CD, lymphocyte count was 160 cells/mm(3). The most common symptom was anorectal pain (57 percent), followed by Lumps or warts (28 percent), rectal bleeding (12 percent), discharge (11 percent), and pruritus (6 percent), with 24 percent of patients having multiple complaints. Ana l condyloma was the most prevalent pathology observed (43 percent), of which 10 percent was associated with anal intraepithelial neoplasia. Wide-based anal ulcers were the most frequent noncondylomatous lesions , occurring in 32 percent of patients, with the majority (91 percent) presenting with the chief complaint of anorectal pain. Some of these u lcers mere associated with viral infections: herpes simplex virus (12 percent) and cytomegalovirus (7 percent). However, most ulcers were id iopathic, with negative cultures and biopsies. Other lesions encounter ed included fistulas (14 percent), abscesses (12 percent), hemorrhoids (G percent), and malignancy, with two cases of Kaposi's sarcoma, one case of non-Hodgkin's lymphoma, and one case of squamous-cell carcinom a. More than one anorectal condition was identified in 16 percent of t he patients. CONCLUSIONS: Human immunodeficiency virus infection is as sociated with a wide spectrum of anorectal disease, of which the most common lesions are anal condylomata and painful ulcers. The majority o f these anal ulcers gave negative culture and biopsy results. In addit ion, there seems to be a high incidence of anorectal neoplasia in this patient population.