Skip to main content

Advertisement

SpringerLink
Log in

Anorectal surgery in the HIV+ patient: Update

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

Anorectal surgery in HIV + patients historicially has been viewed with a great deal of nihilism. Advances in medical therapy and better understanding of unique pathophysiologic processes have afforded the colorectal surgeon the ability to treat better and sometimes cure the anorectal complications of AIDS. We present a series of 75 consecutive surgical procedures (1-year accrual) on HIV + (40) and CDC AIDS (22) patients. Surgical procedures, perioperative T cell counts, and outcome will be presented; 53 percent of procedures resulted in complete healing of anal wounds; 30 percent resulted in partial healing with symptomatic relief; 17 percent resulted in symptomatic relief or tissue diagnosis without appreciable wound healing. The healing rate was significantly higher in the HIV + group (69 percent) compared to the AIDS group (26 percent). Perioperative T cell counts did not have predictive value on outcome. No patients suffered significant unexpected morbidity, mortality, or incontinence. Pathophysiologic mechanisms of several disease processes unique to HIV + patients and data from our ongoing investigation using RNA hybridization are presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. CDC Update. Estimation of HIV prevalence and proected AIDS cases. MMWR 1990;39:110–19.

    Google Scholar 

  2. CDC Update. Acquired immunodeficiency syndrome—United States. MMWR 1989;39:81–6.

    Google Scholar 

  3. Wexner SD, Smithy WB, Milsom JW, Dailey TH. The surgical management of anorectal diseases in AIDS and pre-AIDS patients. Dis Colon Rectum 1986;29:719–23.

    Google Scholar 

  4. Rompalo AM, Stamm WE. Anorectal and enteric infections in homosexual men. West J Med 1985;142:647–52.

    Google Scholar 

  5. Sohn N. The rectum in AIDS. Pract Gastroenterol 1988;12:50–60.

    Google Scholar 

  6. CDC Update. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 1987;36:3S–15S.

    Google Scholar 

  7. Laurence J. HIV infection and the female genital tract. Inf Surg 1988;Jan:31–5.

    Google Scholar 

  8. Ioachim HC, Weinstein MA, Robbins RO, Sohn N, Lugo P. Primary anorectal lymphoma: a new manifestation of the acquired immunodeficiency syndrome. Cancer 1987;60:1449–53.

    Google Scholar 

  9. Kaplan MH, Susin M, Phawa SG,et al. Neoplastic complications of HTLV-III infection. Am J Med 1987;82:389–96.

    Google Scholar 

  10. Monfardini S, Vaccher E, Pizzocaro G,et al. Unusual malignant tumors in 49 patients with HIV infection. AIDS 1989;3:449–52.

    Google Scholar 

  11. Barbul E, Breslin RJ, Woodyard JP, Wasserkrug HL, Efron G. The effect ofin vivo T helper and T suppressor lymphocyte depletion on wound healing. Ann Surg 1989;209:479–83.

    Google Scholar 

  12. Fishel RS, Barbul A, Bisehorner WE, Wasserkrug HL, Efron G. Lymphocytic participation in wound healing: morphologic assessment using monoclonal antibodies. Ann Surg 1987;206:25–9.

    Google Scholar 

  13. Trofatter KF Jr. Interferon. Obstet Gynecol Clin North Am 1987;14:537–8.

    Google Scholar 

  14. Krebs H-B, Schneider V, Hurt WG, Goplerud DR. Genital condylomas in immunosuppressed women: a therapeutic challenge. South Med J 1986;79:183–7.

    Google Scholar 

  15. Reichman RC, Strike DG. Pathogenesis and treatment of human genital papillomavirus infections: a review. Antiviral Res 1989;11:109–18.

    Google Scholar 

  16. Armstrong B, Jenson OM, Munoz N, Bosch FX. Human Papillomavirus and cervical cancer. Lancet 1988;1:756–7.

    Google Scholar 

  17. Androphy E. Human papillomavirus: current concepts. Arch Dermatol 1989;125:683–5.

    Google Scholar 

  18. Beckman A, Daling J, Sherman K,et al. Human papillomavirus infection and anal cancer. Int J Cancer 1989;43:1042–9.

    Google Scholar 

  19. Duggan M, Boras V, Inouc M, McGregor M, Robertson I. Human papilloma DNA determination of anal condylomata, dysplasias, and squamous carcinomas within situ hybridization. Am J Clin Pathol 1989;92:16–21.

    Google Scholar 

  20. Nuovo G, Pedemonte B. Human papilloma virus types and recurrent cervical warts. JAMA 1990;263:1223–6.

    Google Scholar 

  21. Friedman-Kien AE, Eron LI, Conant M,et al. Natural interferon alpha for the treatment of condyloma acuminata. JAMA 1988;259:533–8.

    Google Scholar 

  22. Reichman RC, Oakes D, Bonnez W. Treatment of condyloma acuminatum with three different interferon preparations administered intralesionally: a double-blind placebo-controlled trial. Ann Intern Med 1988;108:675–9.

    Google Scholar 

  23. Douglas J Jr, Rogers M, Judson F. The effect of asymptomatic infection with HTLV-III on the response of anogential warts to intralesional treatment with recombinantα 2 interferon. J Infect Dis 1986;154:331–4.

    Google Scholar 

  24. Rampalo AM, Mertz GJ, Davis G,et al. Oral acyclovir for treatment of first-episode herpes simplex virus proctitis. JAMA 1988;259:2879–81.

    Google Scholar 

  25. Reichman RC, Badger GJ, Mertz GJ,et al. Treatment of recurrent herpes simplex infections with oral acyclovir: a controlled trial. JAMA 1984;251:2103–8.

    Google Scholar 

  26. Wexner SD, Smithy WB, Trillo C, Hopkins BS, Dailey TH. Emergency colectomy for cytomegalovirus ileocolitis in patients with the acquired immune deficiency syndrome. Dis Colon Rectum 1988;31:755–61.

    Google Scholar 

  27. Dieterich DT, Chachoua A, Lasfleur F, Worrell C. Ganciclovir treatment of gastrointestinal infections caused by cytomegalovirus in patients with AIDS. Rev Infect Dis 1988;10(supp 3):S532–7.

    Google Scholar 

  28. Kreiss JK, Coombs R, Plummer F,et al. Isolation of human immunodeficiency virus from genital ulcers in Nairobi prostitutes. J Infect Dis 1989;160:380–4.

    Google Scholar 

  29. Fox CH, Kotler D, Tierney A, Wilson CS, Fauci AS. Detection of HIV-1 RNA in the lamina propria of patients with AIDS and gastrointestinal disease. J Infect Dis 1989;159:467–71.

    Google Scholar 

  30. Nelson JA, Wiley CA, Reynolds-Kohler C, Reese CE, Margaretten W, Levy JA. Human immunodeficiency virus detected in bowel epithelium from patients with gastrointestinal symptoms. Lancet 1988;1:259–62.

    Google Scholar 

  31. Bach MC, Howell DA, Valenti AJ, Smith TJ, Winslow DL. Aphthous ulceration of the gastrointestinal tract in patients with AIDS. Ann Intern Med 1990;112:465–66.

    Google Scholar 

  32. Dretler RH, Rausher DB. Giant esophageal ulcer healed with steroid therapy in an AIDS patient. Rev Infect Dis 1989;11:768–9.

    Google Scholar 

  33. Bach MC, Valenti AJ, Howell DA, Smith TJ. Odynophagia from aphthous ulcers of the pharynx and esophagus in the AIDS. Ann Intern Med 1988;Aug:338–9.

    Google Scholar 

  34. Levine AM. DeVita VT, Hellman S, Rosenberg SA, eds. In: Reactive and neoplastic lymphoproliferative disorders and other miscellaneous cancers associated with HIV infection in AIDS: an etiology treatment and prevention. 2nd Ed. Philadelphia: JB Lippincott, 1988:263–75.

    Google Scholar 

  35. DiCarlo EF, Amberson JB, Matroka CE, Ballard P, Moore A, Mouradian JA. Malignant lymphoma and AIDS. Arch Pathol Lab Med 1986;110:1012–6.

    Google Scholar 

  36. Ioachim HC, Cooper M, Hellman G. Lymphomas in men at high risk for AIDS. Cancer 1985;56:2831–42.

    Google Scholar 

  37. Mehta K, Pawel B. Human immunodeficiency virus-associated large cell immunoblastic lymphoma presenting as a perianal mass. Arch Pathol Lab Med 1989;113:531–3.

    Google Scholar 

  38. Rahman MA, Kingsley LA, Breinig MK,et al. Enhanced antibody responses to Epstein-Barr virus in HIV-infected homosexual men. J Infect Dis 1989;159:472–6.

    Google Scholar 

  39. Cooper HS, Patchefsky AS, Marks G. Cloacogenic carcinoma of the anorectum in homosexual men: an observation of four cases. Dis Colon Rectum 1979;22:557–8.

    Google Scholar 

  40. Nigro ND, Vaitkevicius VK, Considine B Jr. Dynamic management of squamous cell cancer of the anal canal. Invest New Drugs 1989;7:83–9.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Section of Colon and Rectal Surgery, Roosevelt Division, St. Luke's Roosevelt Hospital Center, New York, New York

    Ali Safavi M.D., Lester Gottesman M.D. & Thomas H. Dailey M.D.

Authors
  1. Ali Safavi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lester Gottesman M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas H. Dailey M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, April 29 to May 4, 1990.

About this article

Cite this article

Safavi, A., Gottesman, L. & Dailey, T.H. Anorectal surgery in the HIV+ patient: Update. Dis Colon Rectum 34, 299–304 (1991). https://doi.org/10.1007/BF02050588

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02050588

Key words

Search

Navigation