Barrett W L, Callahan T D, Orkin B A
Department of Surgery, The George Washington University, Washington, DC, USA.
Dis Colon Rectum. 1998 May;41(5):606-11; discussion 611-2. doi: 10.1007/BF02235268.
Individuals infected with the human immunodeficiency virus often have disorders affecting the anorectum. These disorders may be complex and difficult to treat. We reported our early experience with 40 human immunodeficiency virus-positive patients with perianal disorders in 1990. We now present our series of 260 consecutive human immunodeficiency virus-positive patients with perianal disorders who underwent evaluation between 1989 and 1996 to examine the distribution of disorders, their treatments, and outcomes.
Patients were identified at initial presentation and followed prospectively.
Two-hundred forty-nine (96 percent) of 260 patients were male, with an average age of 34.9 (range, 19-58) years. Average duration of human immunodeficiency virus positivity was 5 years, 5 months, with a maximum of 11 years, 5 months. Median CD4 count was 175 (range, 2-1,100) cells/mm3. Only 89 (34 percent) patients satisfied the criteria of the Centers for Disease Control and Prevention's for acquired immunodeficiency syndrome at presentation. The most frequent major presenting symptoms were anorectal pain (55 percent), a mass (19 percent), and blood in the stool (16 percent). Risk factors included homosexuality (75 percent) and a prior history of sexually transmitted disease (45 percent). Forty different perianal disorders were identified, which were categorized as benign noninfectious (18), infectious (14), neoplastic (6), and septic (2). The most common disorders were condyloma (42 percent), fistula (34 percent), fissure (32 percent), and abscess (25 percent). Neoplasms were present in 19 patients (7 percent). One hundred seventy-one patients (66 percent) had more than one disorder, with an average of 2.9 disorders among these patients. Four hundred eighty-five procedures were performed on 178 patients (2.7/patient), with no mortalities and a 2 percent complication rate. Thirty-one patients (12 percent) died during the course of follow-up, but anorectal disease was the cause of death in only two patients.
Perianal manifestations of human immunodeficiency virus infection are common, often multiple, and varied. Patients with perianal disorders seek treatment throughout the course of the human immunodeficiency virus infection, and a perianal condition may be this disease's initial manifestation. Although recurrence is common and healing delayed, improved overall management of human immunodeficiency virus infection and a healthier human immunodeficiency virus-positive patient population have improved the outcome of surgical intervention in human immunodeficiency virus-infected patients with perianal disorders.
感染人类免疫缺陷病毒的个体常患有影响肛门直肠的疾病。这些疾病可能复杂且难以治疗。我们在1990年报告了我们对40例患有肛周疾病的人类免疫缺陷病毒阳性患者的早期经验。现在我们展示我们收集的1989年至1996年间连续接受评估的260例患有肛周疾病的人类免疫缺陷病毒阳性患者的系列病例，以研究疾病的分布、治疗方法及结果。
患者在初次就诊时被识别并进行前瞻性随访。
260例患者中有249例（96%）为男性，平均年龄34.9岁（范围19 - 58岁）。人类免疫缺陷病毒阳性的平均持续时间为5年5个月，最长为11年5个月。CD4细胞计数中位数为175个/mm³（范围2 - 1100个/mm³）。仅89例（34%）患者在就诊时符合美国疾病控制与预防中心关于获得性免疫缺陷综合征的标准。最常见的主要就诊症状为肛门直肠疼痛（55%）、肿物（19%）和便血（16%）。危险因素包括同性恋（75%）和既往性传播疾病史（45%）。共识别出40种不同的肛周疾病，分为良性非感染性（18种）、感染性（14种）、肿瘤性（6种）和化脓性（2种）。最常见的疾病为尖锐湿疣（42%）、肛瘘（34%）、肛裂（32%）和脓肿（25%）。19例（7%）患者存在肿瘤。171例（66%）患者有一种以上疾病，这些患者平均有2.9种疾病。对178例患者进行了485次手术（平均每位患者2.7次），无死亡病例，并发症发生率为2%。31例（12%）患者在随访过程中死亡，但仅2例患者的死亡原因是肛门直肠疾病。
人类免疫缺陷病毒感染的肛周表现常见、常为多种且多样。患有肛周疾病的患者在人类免疫缺陷病毒感染全过程中均会寻求治疗，肛周疾病可能是这种疾病的初始表现。尽管复发常见且愈合延迟，但人类免疫缺陷病毒感染整体管理的改善以及人类免疫缺陷病毒阳性患者群体健康状况的改善，提高了对患有肛周疾病的人类免疫缺陷病毒感染患者进行手术干预的效果。
