HIV Specialist - March 2021 - 46

BEST PRACTICES

in their recommendations that HIV testing be performed in persons
who present clinically with infectious conditions such as tuberculosis
or sexually transmitted diseases. Furthermore, those at high-risk for
HIV should be screened at least annually.
For the past four years, Georgia has had the highest rate of HIV
diagnoses in the United States (23.8 per 100,000).5 Outside of metropolitan Atlanta (1.02%), Chatham county has the highest prevalence
rate of HIV out of Georgia's most populous counties (0.63%).6 Despite
this, Georgia laws with respect to HIV testing have not changed since
2015.7 While other states, such as New York, have seen declines in
HIV prevalence partially as a result of improved legislation, Georgia
has not adopted similar legislation to combat its prevalence of HIV.8
As a result, many Georgia healthcare facilities do not routinely screen
for HIV per CDC recommendations.
Many healthcare encounters only focus on immediate clinical needs
and therefore neglect to assess and screen for HIV. Studies also show
that approximately 47 percent of patients newly diagnosed with HIV
present at least two or more times to healthcare visits with HIV-related
symptoms; and, of those, only 21 percent actually receive a HIV test.9
As previously stated, our patient presented at 40 healthcare visits with
multiple, potentially HIV-related symptoms in both the primary and
specialty care settings, yet was never tested for HIV. Today, about 14
percent of the general population still do not know their HIV status.9
Since 2014, HIV has been declining in whites and all age groups, with
the exception of those ages 18 to 24.9 During this same time period, CDC
data shows HIV infections are rising in African American males who
have sex with males (MSM). Nationwide, white heterosexual females
represent the lowest number of HIV-positive persons.10 In our case, the
patient did not fit the demographic profile of the typical HIV patient.
The American Cancer Society now recommends colorectal
screening at age 45 and even earlier if a person has a history of cancer
and pelvic radiation treatment.11 As noted, our patient previously
received pelvic radiation for endometrial cancer. Persons living with
HIV/AIDS (PLWHA) already have an increased risk for cancers and
some data indicates that rectal cancer, a NADC, is on the rise among
HIV-infected persons.12
At this time, there are no recommendations indicating PLWHA
should be screened for precancerous polyps and colorectal cancer
(CRC) with colonoscopy earlier than people at average risk. One study
suggested that PLWHA who have low CD4 counts (less than 500
cells/mm3) are nine times more likely to have precancerous polyps
than PLWHA who have a CD4 count over 500 cells/mm3.13 As previously stated, at the time of her HIV diagnosis, our patient had a CD4
count of 134 cells/mm3 and likely had been living with HIV infection
for many years. Another study found that CRC may develop at an earlier age and be more aggressive in PLWHA than in people who do not
have HIV.15 The study also revealed findings indicating there is an association between a longer duration of HIV and development of neoplastic lesions in the distal colon.15 Additionally, it was concluded that
immune suppression (i.e., CD4 count < 200 cells/mm3) is associated
with formation of neoplastic lesions in the distal colon. A third study
also found a correlation between HIV infection and an increased
risk of colorectal adenoma in HIV patients.16 It was determined that

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MARCH 2021   HIVSPECIALIST  WWW.AAHIVM.ORG 

patients with a low CD4 count have the
highest risk for developing CRC.15 The results
of these three studies strongly suggest that
earlier screening for colorectal cancer in
PLWHA could be of benefit.
Approximately 50 percent of patients
diagnosed with a malignancy will receive
radiation therapy (RT) as part of their treatment plan.16 While RT can lead to a reduction
in recurrence and is even curative for some
localized, early stage cancers, it may put
patients at an increased risk for developing
a second primary cancer. In regards to pelvic
RT, patients are at an increased risk for late
toxicity and the development of rectal cancer
due to the proximity of the rectum to the radiation field. One study found that the risk for
development of rectal cancer is increased if
RT is received for a primary endometrial cancer.17 It was also determined that, on average,

ISTOCK/ FG TRADE


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HIV Specialist - March 2021

Table of Contents for the Digital Edition of HIV Specialist - March 2021

HIV Specialist - March 2021 - Cover1
HIV Specialist - March 2021 - Cover2
HIV Specialist - March 2021 - 1
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HIV Specialist - March 2021 - Cover3
HIV Specialist - March 2021 - Cover4
https://www.nxtbook.com/ygsreprints/AAHIVM/hiv-specialist-march-2021
https://www.nxtbook.com/ygsreprints/AAHIVM/G121337_AAHIV_122020
https://www.nxtbook.com/ygsreprints/AAHIVM/G119632_AAHIV_092020
https://www.nxtbook.com/ygsreprints/AAHIVM/G118334_AAHIV_062020
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