ウイルスと悪性腫瘍～耳鼻科領域で判明するHIV感染症

抄録

Almost over 30 years after its first description, the number of HIV (human immunodeficiency virus) patients are still increasing in Japan. Although HIV infection may produce no clinical symptoms for several years in general, most of develop symptoms that indicate progression of AIDS including HIV-related malignancy after many years of infection. It is well known that up to 80% of HIV-infected patients eventually develop some Ear-Nose-Throat clinical manifestations, such as lymphadenopathy, including candidiasis, periodontal and gingival disease, HSV and HPV infection, oral hairy leucoplakia, Kaposi’s sarcoma, and non-Hodgkin’s lymphoma. According to Anti-Retroviral Therapy (ART) era, people who get infected with HIV can live a longer much the same to general population. Cancer Incident Rate Ratio (IRR) in HIV patients have shown in Kaposi’s sarcoma (IRR 374.73), Non-Hodgkin Lymphoma (IRR 48.71) compared to general population. Interestingly, incidence of HIV-related malignancy (i.e. malignant lymphoma, Kaposi’s sarcoma) have been decreasing, however non-HIV related malignancy (i.e. colon cancer, lung cancer) have been increasing in HIV-population. In general, biopsy is the only way for making definitive diagnosis for HIV-related/non-related malignancy. The rate of infection due to exposure during medical proceedings in HIV patients (0.1–0.3%) is considered much less than HBV (HBe-Antigen positive: 30%), and HCV (1–3%) patients. It should not be feasible for any surgical proceedings for HIV patients with indication. The Z-score is supportive information for making decision to performing lymph-node biopsy (Sensitivity 97%, Specificity 56%). Appropriate and quick preforming HIV-testing may let a person with high risk of getting infected with HIV live decades longer as general population without developing AIDS. ENT doctors should be aware of the ENT manifestations associated with HIV disease including cancer, and the respective early detection, diagnosis, and treatment.