0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
374 Complications of Human Immunodeficiency Virus Type 1associated with transmission); some sexual and blood transfusion
related transmission; other modes include blood-borne transmis-
sion from tattooing, piercing, sharing razors, dental supplies and
other personal items; accelerated progression to cirrhosis esp. if con-
comitant alcohol use
■Human Papilloma Virus (HPV): worldwide; transmitted by close
contact±minor trauma; anogenital warts transmitted sexually, little
evidence exists to suggest that condoms reduce the risk for infection
with HPV; HIV+women are 2-3 times more likely to have detectable
HPV DNA in cervicovaginal specimens and 5 times more likely to
have squamous intraepithelial lesions (SILs), vulvovaginal condylo-
mata acuminata, or anal intraepithelial neoplasia
■Epstein-Barr Virus (EBV): widespread; acquired early in life; found
in oropharyngeal secretions
■Molluscum contagiosum: worldwide; spread by direct contact; dis-
ease rare in the immunocompetent
Tumors
■Kaposi Sarcoma (KS): The mechanism of transmitting human her-
pesvirus 8 (HHV-8), the herpesvirus associated with Kaposi’s sar-
coma (KS), is not known; sexual transmission is likely among men
who have sex with men and can occur among heterosexuals as well;
however, the virus has been detected more frequently in saliva than
in semen
■Lymphoma: Hodgkin’s lymphoma, Non-Hodgkin’s lymphoma (NHL)
with most being B-cell lymphomas, and Burkitt’s lymphoma found
more frequently among HIV+persons; primary central nervous sys-
tem lymphoma (PCNSL) 1000-fold more common; evidence that
Epstein-Barr virus (EBV ) is associated with these lymphomas (not
clear for Hodgkin’s)
■PBCL (HHV8):
■Cervical cancer: associated with HPV infection esp. with types 16
and 18; an AIDS-defining diagnosis; incidence remains low although
prevalence of SIL and cervical intraepithelial neoplasia (CIN) is high;
more likely to present with advanced disease, have persistent or
recurrent disease, short survival after diagnosis, and to die from cer-
vical cancer
■Anal Cancer: associated with HPV infection esp. types 16 and 18;
HIV+women and men who have sex with men at increased risk
■Other Cancers: increased incidence of leiomyosarcomas and leiomy-
omas in HIV+persons esp. HIV+children, also associated with EBV