HPV blood test shows promise for tracking head and neck cancer after treatment

A new blood test developed by University of North Carolina Lineberger Comprehensive Cancer Center researchers shows promise for tracking HPV-linked head and neck cancer patients to ensure they remain cancer-free after treatment.

Researchers will present preliminary findings at the 60th Annual Meeting of the American Society for Radiation Oncology in San Antonio on Tuesday, Oct. 23. Their study evaluated a blood test for HPV-linked oropharyngeal squamous cell carcinoma, which is a cancer of the back of the throat. The findings demonstrated the test could be an effective and less costly alternative for monitoring for cancer recurrence after radiation treatment.

"The goal of this study was to evaluate whether this test can be used to track patients who are completely asymptomatic, and thought to have no active cancer," said UNC Lineberger's Gaorav P. Gupta, MD, PhD, assistant professor in the UNC School of Medicine Department of Radiation Oncology. "We already knew that our test was very sensitive and specific, but we did not know the degree to which it would be useful in early detection of disease recurrence in patients who are otherwise thought to be disease-free."

HPV, or the human papillomavirus, is the most common cause of sexually transmitted infection in the United States, according to the U.S. Centers for Disease Control and Prevention. Infection with certain strains of HPV can cause cervical cancer in women, genital cancers in both men and women, and cancer of the oropharynx, which is the back of the throat, including the base of the tongue and tonsils. The CDC estimates that approximately 70 percent of oropharyngeal cancer cases diagnosed in the United States are probably caused by HPV, which accounts for nearly 13,000 cases per year.

Gupta and his colleagues developed a blood test that can detect fragments of HPV's genetic material that have been released into the blood by dying cancer cells.

"We realized it is important to distinguish HPV DNA that's being released by dying tumor cells from the natural HPV DNA that is present during a viral infection," Gupta said. "Our method accomplishes this feat, thus making it a more sensitive and specific test for cancer."

For their study, the researchers followed 89 patients with HPV-associated oropharyngeal squamous cell carcinoma who received chemotherapy and radiation treatment. They administered the blood test before and during treatment, and then during follow-up visits. The patients received scans three months after treatment, and then came back for clinical exams every two to four months during the first two years, and then every six months in years three through five. Patients received X-rays or CT scans every six months, and again if they had positive HPV results.

"We are detecting subclinical disease with this blood test, and the imaging patients received confirmed those findings," said UNC Lineberger's Bhishamjit S. Chera, MD, associate professor in the UNC School of Medicine Department of Radiation Oncology and the study's co-corresponding author. Chera presented the findings from the study at the ASTRO meeting.

Of the 70 patients whose blood tests were negative three months after treatment, none developed recurrence. Nineteen patients had positive blood tests, and eight of those patients developed recurrence. Physicians are continuing to monitor the remaining eleven who had positive blood tests but no evidence of recurrence.

"The most striking finding of our study is that of the patients who did not have any signal using our blood test, none of them developed disease recurrence," Chera said. "That raises the question: Do we need to be scanning these patients? Scans come with a lot of cost, and because of the cost, we're not able to do it as frequently. Patients end up having a lot of anxiety from one scan to the next, wondering if their cancer has come back. This blood test could spare patients the need for additional imaging and potentially alleviate some anxiety."

The researchers say the next steps will involve investigating whether the test can be used prospectively to monitor patients and to make decisions that could avoid unnecessary imaging, thereby reducing costs. They also see additional applications for the blood test, including monitoring for other HPV-linked cancers, including cervical cancer.

"We are confident this blood test will be translatable to other cancers driven by HPV, and as a monitoring tool for cancer diagnosis," Chera said. "We strongly believe that this test may also have a role in screening, not just for oropharyngeal cancer, but also cervical or anal cancers, possibly in a general population setting, or at least in patients who may be at higher risk of developing these conditions."

In addition to Chera and Gupta, other authors include Sunil Kumar, PhD; Colette Shen, MD, PhD; Robert Amdur, MD; Roi Dagan, MD; Jared Weiss, MD; Juneko Grilley-Olson, MD; Adam Zanation, MD; Trevor Hackman, MD; Jeff Blumberg, MD; Samip Patel, MD; Brian Thorp, MD; Mark Weissler, MD; Nathan Sheets, MD; and William Mendenhall, MD.

The study was supported by the University Cancer Research Fund, Burroughs Wellcome Fund, the University of North Carolina School of Medicine Department of Radiation Oncology, UNC Lineberger and the University of Florida School of Medicine Department of Radiation Oncology.

Intellectual property related to the test and held by the University of North Carolina at Chapel Hill has been licensed to Naveris, a company in which Chera and Gupta hold equity stakes.

Source: https://www.sciencedaily.com/releases/2018/10/181023085744.htm

Registration: https://std-hiv-aids.cmesociety.com/registration

Abstract Submission: https://std-hiv-aids.cmesociety.com/abstract-submission

Screening HPV infection alone more accurate than Pap test in detection of cervical cancer

Screening for human papillomavirus (HPV) infection alone gives more accurate results than Pap (smear) testing for cervical cancer, say the authors of two papers to published today in the journal Gynecologic Oncology. HPV infection causes almost all cervical cancer, and it is estimated that more than half of sexually active people are infected with HPV at some point in their lives. Now new research has shown that in many cases, an HPV test alone can be used for cervical cancer screening instead of a Pap or cotesting with both an HPV and a Pap test, the researchers say.

In the first paper1, Dr Warner Huh, from the Department of Gynecologic Oncology, University of Alabama, Birmingham, USA, sets out the findings of a panel convened to provide guidance on using HPV as the first-line primary screening test. The panel included representatives from all the major US organizations involved in cervical cancer screening, and addressed questions related to the safety and effectiveness of HPV testing for primary screening and whether it could be considered as an alternative to the screening methods currently in use in the US. The panel was convened because of an application to the Food and Drug Administration (FDA) for an existing HPV test to be used for primary HPV cervical cancer screening. The guidance was based on a literature review and also on review of data from the ATHENA study which was conducted to support the primary screening application to the FDA.

"We found that, in patients aged 25 years and upwards, primary HPV testing performed better than a Pap alone, and we recommend that such tests should be carried out no sooner than every three years. This is an important advance in cervical cancer screening because it offers a better reassurance of low cancer risk compared to Pap screening, which is also carried out at three year intervals," Dr Huh said.

Infection with just two HPV genotypes, 16 and 18, is responsible for about 70% of all invasive cervical cancers worldwide. The panel recommends that patients testing positive for either of these two high risk genotypes should have immediate colposcopy - a procedure using a lighted magnifying device that allows doctors to see abnormal areas in the cervix that would be missed by the naked eye. Women with one of the 12 other HPV genotypes can be followed-up in 12 months with repeat testing with both the HPV test and a Pap.

"We believe that there is still considerable confusion over the three current screening options, and the intervals at which they should be performed. We hope that our deliberations will go some way towards reducing this uncertainty. However, I would still like to see more data from the US, and evidence from other countries using primary HPV screening such as Australia and The Netherlands. But in the absence of data to the contrary, we believe that primary HPV testing has potential to further reduce cervical cancer in the US," Dr Huh said.

The second paper2 reveals end-of-study results of the ATHENA trial which evaluated safety and effectiveness of HPV primary screening as an alternative to Pap in women of 25 years and older. 42,209 women in this age group were enrolled into the trial and had both Pap and HPV testing. Those with abnormal Pap test results and those who were HPV positive were referred for colposcopy.

"We found that HPV primary screening was as effective in women aged 25 years and over when compared to Pap alone for women 25 and 29 and cotesting for those aged 30 and over. However, HPV screening alone requires only one test, and this is important for many women who may not be able to afford the cost of two tests," said Dr Thomas Wright, a Professor Emeritus of Pathology and Cell Biology at Columbia University, New York, USA.

To determine the impact of starting HPV screening at different ages, the researchers compared the prevalence of HPV positivity and Pap abnormalities as well as the three year detection rate of high-grade cervical disease by age group. They found that although HPV positivity was almost twice as high in women aged 25-29 as it was in women aged 30-39, HPV testing identified about twice as many high-grade cervical disease cases in women aged 25-29 than did the Pap.

"When Pap screening is used in this age group, the women with missed high-grade cervical disease are told to return in three years for repeat screening and some are likely to develop invasive cervical cancer", said Dr Wright.

"Our results, from the first prospective US study to evaluate the performance of HPV primary screening, have shown clearly that this new screening approach should be considered as an option for women 25 years and older", Dr Wright said. However, he added that the recent FDA approval for HPV primary screening is limited to a single commercially available HPV test and to only one of the two widely utilised liquid-based Pap tests. "In order to facilitate the widespread adoption of this safe and effective method of screening, it would be advantageous to have additional HPV tests and the other liquid-based Pap tests approved. We hope that our research will help reduce morbidity and mortality from cervical cancer worldwide," he said.

Source: https://medicalxpress.com/news/2015-01-screening-hpv-infection-accurate-pap.html

STD 2018: Scientific Sessions

Session 1: Types of STDs

Sexually transmitted diseases (STDs) are infectious diseases that are transmitted from a person to another through sexual contact or blood of an infected person. The pathogens such as bacteria, virus, fungi, protozoa are responsible for the disease transmission. Bacterial STDs are Syphilis, Gonorrhoea, Chlamydia, Chancroid. Viral STDs include HIV/AIDS, Human papillomavirus, Hepatitis, Genital Herpes. Trichomoniasis is a STD caused by parasitic protozoan. Candidiasis is considered to be an fungal STD which is spread by fungus Candida albicans. Most of the sexually transmitted diseases such as viral STDs have no cure but the disease can be controlled with proper treatment while bacterial, fungal and protozoan STDs can be cured with antifungals and antibiotics.

• Bacterial STDs
• Viral STDs
• Protozoan STDs
• Fungal STDs

Session 2: Evolution of STDs

The evolution of the STD pathogens are caused by the selective pressures of the host-immune response, modern drugs, vaccines or by microbial competition. Through evolutionary phase, a pathogen can become more or less virulent. The phylogeny, epidemiology and origin studies on sexually transmitted diseases provides valuable data on the genetic transition traits in both host and pathogen. The evolutionary study of the disease-causing pathogen provides the disease transmission and diversity among the human population. The clinical epidemiologyand phylogenetic study paves way for new insights for the development of drugs and therapies against the multiple drug resistance.

• Origin
• Phylogenetics
• Epidemiology
• Diversity

Session 3: Immunopathogenesis

The immune system helps in elimination of the invading microbial pathogens in the body through a series of defense mechanism. The innate immune response of the body provides first line of defense against the pathogens which is fast and non-specific response while adaptive immune response is specific and slow. The study of immunopathogenesis allows us to explore the disease transmission process, pathogen-host interactions, immune defense against the STD pathogens. This allows us to understand the pathological condition and progression of the disease and also the genetic factors influencing the immune defense against STD transmission. The genetic factors influence can be used for the development of gene therapies that triggers immune reaction against the disease-causing pathogens in the body.

• Disease Transmission
• Pathogen-Host Interaction
• Innate Immune Response
• Adaptive Immune Response
• Genetic Factors

Session 4: Treatment Strategies

Antibiotics are used for treating the STDs caused by bacteria and protozoa. The bacterial STDs can be cured if the infection is properly diagnosed and treated. Several antibiotic resistant strains of pathogens have developed which pose a serious threat for health of the STD affected individuals. For viral STDs, there are no complete cure but progression of the disease can be controlled by antiretroviral therapies which use multiple antiretroviral drugs to decrease the disease proliferation and reduce other opportunistic infections. Gene therapy involves gene editing approaches which can provide a better and safer alternative to other existing drugs. Novel and emerging treatment strategies can provide a solution for the increasing drug resistance in the pathogens.

• Antibiotic Therapy
• Antiretroviral Combination Therapy
• Immunotherapy
• Gene Therapy

Session 5: STDs Prevention

Sexually Transmitted Diseases are transmitted from a person to another through sexual contact or blood transfusions from an infected person or needle sharing, or from mother to infant during pregnancy, labor and breastfeeding. STDs can be prevented through vaccination, screening and through promoting safer sexual behaviour, early health-care seeking behaviour, prevention and care activities. Pregnant women affected with STD must take proper treatment to prevent the vertical transmission of STD. Most STDs cannot be cured and leads to infertility, birth defects in infants, co-infections, opportunistic infections and many other health issues.

• Effective Healthcare Systems
• Vaccination
• Preconception Care
• Prenatal Care

Session 6: Advanced Diagnostic Tools

Diagnosis of STDs are done by serological assays, amplification techniques, immunological diagnosis attains accurate result of the diagnosis. Point-of-care test enables rapid screening of Syphilis and allows treatment without delay. Nucleic acid amplification tests monitor the infection trends and helps in the adaptation of treatment protocols. Drug-resistance test provides the provisions for identifying drug resistance in the STDswhich aids in overcoming the resistance and provide a better treatment. Further improvements in the diagnosis method can help in rapid and cost-effective method for screening of the STDs.

• Nucleic acid Tests
• Serological Assays
• Amplification Techniques
• Immunological Diagnosis
• Drug-Resistance Testing
• Point- of-Care Test

Session 7: Drug Development and Research

Drug development and research is the development and invention of new drugs and improvement of existing drugs. Continuous progress in drug development and research field is necessary for invention of new drugs and drug targets for STDs. Identification of the drug target is the basis of the drug development process, this can be done through various computational approaches. Gene editing technology such as CRISPR seeks to eliminate the latent as well active HIV infection in the human which would be more effective in the treatment of AIDS. Various viral inhibitors such as entry inhibitors, maturation inhibitors are designed to inhibit the replication of the virus inside the host cell.

• New Drugs and Drug Targets
• Integrase Inhibitors
• Entry Inhibitors
• Maturation Inhibitors
• Gene Editing

Session 8: Vaccines Development

A highly effective method for controlling infectious diseases is vaccination, it helps in prevention of high risk health issues. Prophylactic vaccines are those used for prevention while therapeutic vaccines are used for treatment of the specific disease. Sexually transmitted diseases are spread by pathogens such as bacteria, virus, fungi and protozoa. Many viral STDs doesn't have cure hence preventing the infection through vaccination is a best method. Vaccines are developed for Hepatitis and Human Papillomavirus (HPV) infection and for HIV and Herpes virus vaccines are being developed. Vaccination is the primary solution for eradication of sexually transmitted diseases in human.

• Pre-Exposure Prophylaxis
• Post-Exposure Prophylaxis
• Therapeutic Vaccines
• Advancements in Vaccine Technology
• HIV and Genital herpes Vaccine Development

Session 9: Nanotechnology in HIV Treatment

Nanotechnology is the science and engineering of structures that are 1–100 nm in size. Nanomedicine is a branch of medicine which is employed in preventive, diagnostic and therapeutic purposes. Using nanoparticles, effective timely release of drugs to the infected areas/organs are possible which improves specificity of drug action. HIV/AIDS patients face a major problem where the virus resides in latent reservoirs makes it hard to reach for drugs. Nanoparticles has the ability to travel through the body with less interruption which aids in effective release of drugs at HIV virus reservoirs at the specific target. Therapeutic nanoparticles have higher specificity for the drug targets which enhances the treatment efficiency and better cure for the affected individual.

• Drug Delivery System
• Drug Nanosuspension
• Therapeutic Nanomaterials
• Nanoparticle Based Vaccines

Session 10: Phytochemicals in STDs Treatment

Plants contain a wide range of substances that are used for treating chronic as well as acute infectious diseases. Many modern drugs in use have been developed from the medicinal plants which has been used by indigenous people. Phytochemicals are chemicals secreted by plants that have disease preventive properties that is used by the plants to protect itself from diseases. Antimicrobial activity of the plant sources can act as a better drug for the strains that has developed multiple drug resistance to antibiotics. Many bacterial STDs can be combated using phytochemicals produced by the medicinal plants. Pharmacological effects of the bio active compounds in the plants must be explored to produce a cure for the multiple drug resistant bacterial STDs.

• Antimicrobial Effect of Phytochemicals
• Phytoconstituents and its Effects on STDs
• Novel Therapeutic Drugs
• Multi-Drug Resistance and Phytochemical Drugs

Session 11: Drug Resistance and Mutation

The infectious pathogens mutate under certain circumstances to overcome the pressure inflicted upon them. Such organisms develop resistance to the drug in use. This proves to be a major problem in the treatment of sexually transmitted diseases. Human immunodeficiency virus has developed resistance to the antiretroviral drug provided. Hence combination antiretroviral therapies are used for treating AIDS which involves using two or more antiretroviral drugs together. Several bacterial species has also developed resistance to the antibiotics provided for the treatment. The mutation of the pathogens has led to development of drug resistance against many antibiotics and antiretroviral drugs.

• Nucleoside Reverse Transcriptase Inhibitors Resistance
• Non-Nucleoside Reverse Transcriptase Inhibitors Resistance
• Protease Inhibitors Resistance
• Antibiotic Resistance
• Antiviral Drug Resistance

Session 12: STDs and Cancer

Sexually transmitted diseases increases the risk of being affected by cancer. Among the STDs which lead to cancer, human papillomavirus infection is found to cause cervical cancer in women and penile cancer in men. It is also responsible for the development of oropharyngeal cancer in both sexes. Untreated STDs has a higher risk for leading to development of cancer. The progression of cancer in people affected by STD must be analyzed to understand the causative agents of the cancer.

• Oropharyngeal Cancer
• Cervical Cancer
• Penile Cancer
• Prostate Cancer

Session 13: Co-Infection of STDs

Gonorrhoea, chlamydia and trichomoniasis cause immune reactions which leads to inflammation that can easily be infected with HIV. Co-infection is a condition where a person actively infected with STD is infected with another STD. when a STI infected individual is prone to another infection due to immune compromise they are less able to mount a protective response against sexually transmitted pathogens. Treating co-infected individuals can be challenging and the treatment methods must be analyzed and modified to their needs.

• HIV and Gonorrhea
• HIV and Hepatitis
• HIV and Kidney disease
• HIV and Tuberculosis

Session 14: Infertility and Birth Defects

When an STD infection is left untreated in women, it may be lead to pelvic inflammatory disease (PID). Being affected by pelvic inflammatory disease may lead to infertility or ectopic pregnancy in pregnant women. When the mother is infected by STD, the fetus or new born is mostly infected. STDs during pregnancy can lead to miscarriage, birth defects including blindness, deafness, bone deformities, and intellectual disability, stillbirth, premature birth. In males, reduced fertility or infertility is most common side effect of the disease.

• Ectopic Pregnancy
• Premature Birth
• Neonatal Sepsis
• Neurological Defects

Session 15: Vertical STD Transmission

Vertical STD transmission is the process of transfer of STD from a mother to infant perinatally or postnatally. During delivery, when the baby passes through the infected canal, it can contract the STDs such as chlamydia, gonorrhoea, genital herpes from the infected mother. Syphilis and HIV can be contracted from the mother during fetus development. Postnatal transmission of the disease is possible through breastfeeding the baby. Vertical STD transmission poses serious threat to the health of the baby.

• Perinatal Transmission
• Postnatal Transmission
• Prevention of STD Transmission
• Pregnancy Care and Treatment

Session 16: Paediatric STDs

Sexually Transmitted Diseases are an important cause of morbidity in paediatric patients. The transmission occurs via transplacental, intrapartum, and postpartum exposure. When an infant contracts STD from mother, it can affect the skin, eyes, mouth, central nervous system, and can also lead to organ failure. With treatment, the chances of transmitting HIV from mother to infant is low. Proper awareness, treatment and diagnosis is needed to prevent the transmission of STDs among young people.

• Clinical Manifestation
• Early Diagnosis
• Risk Factors
• Preventive Measures

Session 17: Multimorbidities and complications

Multi-morbidities is the presence of two or more chronic diseases at the same time. Super infection or re-infection is the condition where a person with HIV infection acquires infection with the sub-type of HIV. Re-infection affects the treatment which can deteriorate the health of the affected individual. The STDs affected individual suffers from other social and emotional complications which may also have adverse effects in the health of the individual. Multiple morbidities associated with the disease causes more damage to the health as the immune system would be compromised by the STD.

• Opportunistic Infection
• Superinfection/Reinfection
• Behavioral Complications
• Social Complications

Session 18: Public Awareness and Knowledge of STDs

Educational and awareness programs must be conducted to improve the public knowledge about the sexually transmitted diseases. People affected by sexually transmitted diseases have dramatically increased, millions of people are affected by the disease due to lack of awareness. Public must be aware about the impact of STDs on the lives of the affected people and the importance of preventing, screening and treating STDs. Poor knowledge about the STDs lead to increased health issues such as ectopic pregnancies, infertility and other complications. STDs are a major health issue that affects mostly young people, not only in developing countries but in developed countries also.

• Impact of STDs
• STD Screening
• Risk Awareness
• Prevention Education
• Community Awareness

 

Co-Infections of Sexually Transmitted Diseases

With early diagnosis, proper monitoring and care, most of the illnesses caused by HIV can be prevented. They are much less frequent than they were before effective anti-HIV drugs became available.

There are a number of infections and illnesses that can develop in people who are living with HIV, particularly those people who are not able to take anti-HIV drugs. Some of these life-threatening infections are called opportunistic infections. These only occur if your immune system is quite weakened (usually in the absence of anti-HIV drug therapy) and your body becomes vulnerable to infections that would not affect you otherwise.

Co-infections are illnesses that can occur in people with normal immune systems, but they can impact how you live with HIV.

Some types of cancers are thought to be more common in people with HIV.

Increasingly, the distinction between these different types of infections—life-threatening infections, co-infections and even some cancers—is blurred, as some infections can fit all three categories (for example, human papillomavirus is a co-infection which can lead to cervical and anal cancer).

Life-threatening infections

These infections occur only when a person’s immune system has been seriously weakened by HIV due to lack of diagnosis and/or anti-HIV treatment. HIV attacks immune cells called CD4+ cells, which are needed for fighting off infections and some cancers. A normal CD4+ cell count in an HIV-negative person is around 500 to 1,500 cells in each cubic millimetre (mm³) of blood. If your CD4+ cell count gets lower, your immune system becomes unable to fight off a number of common viruses, bacteria and parasites. These infections can then take hold. (They are sometimes called opportunistic infections because they take advantage of your weakened immune system.)

Life-threatening infections are uncommon now, since most people take anti-HIV drugs, which controls their viral load, raises their CD4+ levels and stabilizes and restores immune system function. This helps prevent life-threatening infections caused by HIV.

The main danger nowadays is in not finding out you are HIV-positive until your CD4+ cell counts are already so low that you are at risk or are already sick with a life-threatening infection.

The more common life-threatening infections are listed in the accompanying table. Some of these can still occur in people with relatively high CD4+ levels but are more serious when the immune system is weakened.

Life-threatening infections include a lung infection called Pneumocystis pneumonia (PCP), an eye infection caused by cytomegalovirus (CMV), a brain infection called toxoplasmosis, and a generalized infection called Mycobacterium avium complex (MAC). If it happens that you find out you have HIV when your CD4+ cell count is very low, there are drugs you can take to prevent these infections. This is called prophylaxis.

Co-infections

Hepatitis

These are infections that can occur even in people with HIV who have adequate CD4+ levels—just as they can occur in people who do not have HIV. They are called co-infections because you have them along with HIV. Co-infections can complicate your HIV treatment and make living with HIV more difficult. HIV can also complicate the treatment and diagnosis of a co-infection. Although they may occur at normal CD4+ levels, the lower your CD4+ cell count is, the more of a problem they can be.

Chronic hepatitis is an increasingly common co-infection for many people with HIV. Hepatitis is a liver condition usually caused by viruses called hepatitis A, hepatitis B or hepatitis C. These viruses infect the liver and can cause jaundice (yellow skin and eyes), dark urine, pale stool and severe fatigue. It is a good idea for your doctor to check regularly for these infections. Hepatitis B and C are transmitted by:

·         blood-to-blood contact through sharing drug-using equipment, or personal care items like razors;

·         transfusion of blood and blood products before 1992 when the Canadian system started screening;

·         unprotected sexual intercourse;

·         being passed from mother to child during childbirth.

Hepatitis A is another, usually less serious, viral infection of the liver. Hepatitis A is spread through feces (shit), and you can be infected by contaminated food (for instance, if someone handling your food has hepatitis A and did not wash his or her hands). If you are exposed to hepatitis A, it can make you quite sick for a few weeks, but your immune system usually clears it. Hepatitis A very rarely causes permanent damage unless you already have hepatitis B or C as well.

If infected with the hepatitis A or B virus, some people get over the initial liver infection and develop immunity. This is much less likely to happen in people with HIV who are co-infected with hepatitis C. Without treatment, people can develop chronic hepatitis, remain infectious to others and develop ongoing liver problems.

As described below, there are vaccinations that will prevent you from getting hepatitis A and B infection. There is no vaccination available for hepatitis C.

Effective antiviral treatments are available for both hepatitis B and C infection. Treatment can cure hepatitis C and keep hepatitis B under control. There are interactions between drugs to treat hepatitis and HIV, so make sure you see a doctor with expertise in both conditions.

Tuberculosis (TB)

TB is a concern for people with HIV because it is so easily spread, especially in places where people live close to each other, in poverty and without adequate medical care.

TB usually infects the lungs, but it can also affect the bones, brain and other organs in your body. TB is spread through the air when someone with active TB coughs or sneezes. Diagnosis of TB is done by skin tests, tests of your sputum (phlegm) and chest X-rays. There are effective treatments for TB, but they need to be taken every day for many months. Missing doses, or stopping before the full treatment period is over, can cause the TB infection to become drug-resistant and much more difficult to treat. People with HIV with a history of previously treated TB may have it reactivate (come back again) if their immune system weakens.

Herpes infections

Herpes is a family of viruses that includes:

·         Herpes simplex, which causes cold sores on the mouth or painful sores on the genitals.

·         Varicella-zoster, which initially causes chicken pox and when reactivated causes painful sores called shingles anywhere on the skin.

Herpes infections are common and are often transmitted by physical contact and sex. Usually, the immune system keeps herpes infection under control until something like stress or a high fever brings the sores out in an outbreak lasting seven to 10 days, or longer. The lower your CD4+ cell count, the more frequent outbreaks may be. They may also last longer.

People with HIV with extremely weak immune systems (CD4+ cell counts less than 100 cells/mm3) are at risk for herpes infections all over the body (disseminated herpes) or in the brain (herpes encephalitis). People with frequent herpes outbreaks (even with normal CD4+ levels), or people at risk for more serious herpes infections, can take antiviral drugs—usually valacyclovir or similar drugs—to keep the herpes virus suppressed.

Fungal infections

Fungal or yeast infections can happen whether you are HIV-positive or not. Women get vaginal yeast infections, and men and women can get athlete’s foot or fungal infections on the skin or nails. The more weakened your immune system is, the more this can be a problem.

Even people with moderate CD4+ cell counts can get a fungal infection in the mouth or vagina called candidiasis or thrush. Antifungal creams, pills and vaginal suppositories are available to treat these problems, and probiotic supplements or yoghurts with friendly bacteria may also help. Watch your diet because the more sugar you eat, the more susceptible you are to fungus, which loves sugar.

Sexually transmitted infections

Some of the infections discussed above can be passed on in many ways, including through sex. Some other infections, like chlamydia, gonorrhea and syphilis, and the virus HPV, are virtually always transmitted sexually. 

Cancers

Cancer is the abnormal and uncontrolled growth of cells in different parts of the body. These cancerous growths then destroy healthy cells and cause serious illness. A normally functioning immune system acts to suppress this abnormal growth of cells.

People with HIV can become more vulnerable to certain types of cancer. Some of these cancers occur only when the immune system is weakened. Other cancers seem to be more common in people with HIV even when their immune system is relatively healthy.

Kaposi’s sarcoma

Kaposi’s sarcoma (KS), a rare form of skin cancer, is caused by a member of the herpes virus family and can be life-threatening.  It causes purple lesions on the skin that looked like bruises. Although slow growing, if it spreads to internal organs it could lead to illness and death. In the early days of HIV, it was quite common in people living with HIV. When HAART was introduced, KS became uncommon and now only occurs in people with very weak immune systems.

Non-Hodgkin’s lymphoma

When the cells in the lymph nodes become cancerous, this is called lymphoma. The non-Hodgkin’s type of lymphoma (NHL) is more common in people with HIV. The symptoms of NHL may include persistently swollen lymph glands, fevers, chills and sweats and weight loss. In the case of central nervous system lymphoma, the symptoms are often headaches and seizures.

Diagnosis of lymphoma, like many cancers, is done by biopsy where a sample of tissue from a swollen lymph node is examined under the microscope for evidence of abnormal cells. In the event of central nervous system lymphoma, the diagnosis is made by examining cerebrospinal fluid tapped from the spine. Lymphoma is usually treated by chemotherapy, where powerful anti-cancer drugs are injected into the vein on a regular basis, and/or radiation therapy where high-powered X-rays are directed at the cancer cells.

Cervical cancer

The cervix is the opening of the uterus (womb) inside a woman’s vagina. Sometimes abnormal cells can start to grow on the cervix, usually as a result of HPV infection. Over time, these abnormal growths can become a pre-cancerous condition called cervical dysplasia. If dysplasia is not found and treated, it can become cancer.

To prevent this, all women should have annual Pap tests to look for dysplasia from a small scraping of cells from the cervix. Women with a history of genital warts or cigarette smoking should have Pap exams more frequently. If dysplasia is found, it is usually treated with a laser in a procedure called colposcopy.

The HPV vaccine will protect women from some, but not all, strains of HPV and so it is hoped it will prevent some cases of cervical cancer. However, this vaccine is effective only if it is given before women have been exposed to the HPV strains the vaccine targets.

Anal cancer

Cancer in the anal canal of men and women is similar to cervical cancer. It is also usually caused by infection with HPV and, like cervical cancer, develops over time from dysplasia to cancer. Risk factors include a history of anal sex and/or genital warts. Both men and women with HIV are thought to be more vulnerable to this form of cancer. 

Other cancers

There are many other forms of cancers that people with HIV are thought to be at slightly higher risk for, even without immune suppression. These include Hodgkin’s lymphoma, lung cancer, skin cancer, vaginal cancer in women and testicular and prostate cancer in men. Fortunately, these cancers are not common and can often be successfully treated if they do occur in people with HIV who maintain healthy immune systems with effective anti-HIV drugs.

Source: http://www.catie.ca/en/practical-guides/managing-your-health/12

Abstract Submission: https:/std-hiv-aids.cmesociety.com/abstract-submission

Registration: https://std-hiv-aids.cmesociety.com/registration