Squamous cell carcinoma of the larynx in HIV-positive patients: difficulties in diagnosis and management.
ABSTRACT Patients who are infected with human immunodeficiency virus (HIV) are at increased risk of developing laryngeal squamous cell carcinoma. This malignancy on average appears in a younger age group at a more advanced stage and has a more aggressive course in HIV patients. These patients have difficult management challenges, diagnostically, in staging, and particularly in determining the optimal treatment for each individual patient because their underlying HIV infection can markedly increase morbidity associated with active treatments. They frequently have problems associated with swallowing both before and after treatment. We present two cases that highlight difficulties in the diagnosis and management of these patients as well as post-treatment complications, with particular emphasis on swallowing problems.
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ABSTRACT: The introduction of combination antiretroviral therapy and protease inhibitors has led to reports of falling mortality rates among people infected with HIV-1. We examined the change in these mortality rates of HIV-1-infected patients across Europe during 1994-98, and assessed the extent to which changes can be explained by the use of new therapeutic regimens. We analysed data from EuroSIDA, which is a prospective, observational, European, multicentre cohort of 4270 HIV-1-infected patients. We compared death rates in each 6 month period from September, 1994, to March, 1998. By March, 1998, 1215 patients had died. The mortality rate from March to September, 1995, was 23.3 deaths per 100 person-years of follow-up (95% CI 20.6-26.0), and fell to 4.1 per 100 person-years of follow-up (2.3-5.9) between September, 1997, and March, 1998. From March to September, 1997, the death rate was 65.4 per 100 person-years of follow-up for those on no treatment, 7.5 per 100 person-years of follow-up for patients on dual therapy, and 3.4 per 100 person-years of follow-up for patients on triple-combination therapy. Compared with patients who were followed up from September, 1994, to March, 1995, patients seen between September, 1997, and March, 1998, had a relative hazard of death of 0.16 (0.08-0.32), which rose to 0.90 (0.50-1.64) after adjustment for treatment. Death rates across Europe among patients infected with HIV-1 have been falling since September, 1995, and at the beginning of 1998 were less than a fifth of their previous level. A large proportion of the reduction in mortality could be explained by new treatments or combinations of treatments.The Lancet 12/1998; 352(9142):1725-30. · 39.06 Impact Factor
- American Journal of Clinical Oncology 01/1999; 21(6):623-4. · 2.55 Impact Factor
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ABSTRACT: To evaluate the prognostic impact of presentation-to-diagnosis interval (PDI) and its association with other clinical factors in patients with oropharyngeal squamous cell carcinoma (OpSCC). Retrospective cohort study. Otolaryngology clinic of an academic medical center. Eighty-seven patients with OpSCC referred to the otolaryngology service at the Johns Hopkins Medical Institutions from March 1994 to August 2001 were included in the study. Selection criteria included confirmed pathological diagnosis of OpSCC, availability of referral record for PDI determination, and no past history of oropharyngeal cancer. The PDI is defined as the time between the patient's first presentation to a medical professional for tumor-related symptoms and the time when the diagnosis of OpSCC was made. The prognostic impact of PDI and its association with other clinical factors were assessed using univariate and multivariate analyses. Forty percent of patients (35/87) had a PDI of 3 months or longer. Referred otalgia, active smoking status at the time of diagnosis, stage IV disease, and advanced T stage were associated with a poor prognosis. Prolonged PDI itself was not associated with a significant decrease in survival in univariate analysis (hazard ratio, 1.27; P =.52). Furthermore, no significant correlation was found between PDI and N stage, T stage, young age at presentation (<45 years), or tobacco use. Difficulty in making the diagnosis of OpSCC is evident by the high proportion of patients with PDI of 3 months or longer. The PDI does not appear to have an impact on survival. Referred otalgia, widely recognized as a strong indicator of invasive head and neck cancer, portends a poor prognosis.Archives of Otolaryngology - Head and Neck Surgery 01/2004; 130(1):45-51. · 1.78 Impact Factor