Overview
AIDS-related anorectal disease is a disease in which human immunodeficiency virus infection causes various symptoms in the anus and rectum. The disease is common in young adults and is prevalent in gay men, more often in men than in women. Roughly 34% of people with AIDS develop anal and rectal symptoms, localized opportunistic infections, viral infections and intestinal malignancies. Different regimens are used to treat different lesions of the anus and rectum in patients with AIDS.
Causes
HIV can be transmitted through direct contact with the patient’s body fluids, semen, blood, vaginal secretions, etc. Risky sexual behavior, anal sex, sharing syringes for drug use, transfusion of contaminated blood products and breastfeeding can lead to transmission, and having multiple sexual partners increases the probability of infection.
Symptoms
The disease often manifests itself in a variety of opportunistic infections, viral infections and malignant tumors, with a higher incidence in gay men. The following manifestations are common.
1. Cytomegalovirus infection
Cytomegalovirus infection can be found in more than 10% of patients, which often manifests as proctitis with symptoms of diarrhea, fever, weight loss and blood in stool.
2. Tuberculosis
There may be watery diarrhea, dehydration, absorption disorders, accompanied by severe abdominal pain, and perianal abscesses or ulcers may be found.
3. Kaposi’s sarcoma
Kaposi’s sarcoma is the most common malignant tumor in AIDS patients, mostly seen in men, and it is found in upper gastrointestinal tract. It appears in anorectal area, often manifested as diarrhea, acute and severe sensation and blood in stool. On examination, it can be seen as elevated prune-like warts.
4. Malignant tumor of anal canal
This kind of tumor is more common in gay men.
5. Anal fissure
Anal fissure is a common disease of anorectal area in AIDS patients, and the common symptoms are periodic pain, constipation and blood in stool.
Tests
1. Polymerase Chain Reaction (PCR) technique is positive for Human Immunodeficiency Virus (HIV).
2. Patients with AIDS-related tuberculosis have a positive tuberculin test, and enteroscopic pathologic biopsy reveals foci of caseous necrosis and eosinophilic bacilli.
3. Cytomegalovirus infection can be seen on colonoscopy with anal canal ulcers, and cytomegalovirus can be seen on swab biopsy done at the base.
4. Patients with Kaposi’s sarcoma may bleed on biopsy.
5. Pathological biopsy of patients with malignant tumors of the anal canal may reveal malignant tumor cells.
Diagnosis
1. The patient is an AIDS patient.
2. AIDS-related tuberculosis can be diagnosed by tuberculin test and enteroscopic pathologic biopsy.
3. Cytomegalovirus infection, cytomegalovirus can be seen by doing a swab biopsy at the base, and anal canal ulcers can be seen by enteroscopy.
4. Kaposi’s sarcoma is often found by unintentional tissue biopsy.
5. Pathological biopsy of malignant tumor of anal canal can help to confirm the diagnosis. Squamous cell carcinoma of the anal canal often has a history of genital warts.
Treatment
1. Treatment of primary disease
There is no accurate and effective treatment for AIDS. Anti-HIV drugs, such as zidovudine, can be used to prolong the survival of patients. Immunity enhancers, such as interleukin and interferon, are useful in treating immunodeficiency in AIDS patients.
2. AIDS-related tuberculosis
Drugs such as macrolides and quinolones can be effective.
3. Cytomegalovirus infection
Cytomegalovirus-induced proctitis often leads to fatal bleeding and perforation, and often requires emergency surgical treatment with subtotal colectomy and terminal ileostomy. Mild cases can be treated with medication to control symptoms.
4. Kaposi’s sarcoma
Surgery should be considered only when complications occur, and the scope of resection should be limited to the lesion area and should not be expanded.
5. Malignant tumor of anal canal
Radiotherapy and chemotherapy can be used as the combination of treatment plan, the prognosis of patients is poor, and patients are weak and difficult to tolerate the treatment.
6. Anal fissure
Cleansing and closure of the lesion can relieve the symptoms.