Page 246 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 5 Original Research

tonsillectomy specimens should be based on the presence of Common NHLs occurring with HIV are diffuse large B-cell
established risk factors with consideration of the cost to lymphoma and Burkitt’s lymphoma. Hodgkin’s lymphoma
patients and to spare histopathological resources. 6 does occur, but not as commonly as NHL. 10

A South African study by Von Lierop et al. evaluated the It has been shown that for NADC, the CD4 count does not
impact of HIV on the incidence of adenotonsillar lesions in appear to play a singular role in carcinoma development.
8,11
the paediatric population. Of the 172 patients evaluated in It is thought that co-infection with certain viruses resulted in
their study, 50% were HIV-positive. They detected only one an increased incidence of malignancy. The viruses implicated
case of lymphoma, and the patient was HIV-negative. They are HPV, Epstein–Barr virus (EBV), Hepatitis C and HHV 8.
11
concluded that, given the high cost of pathological There is also a growing body of evidence that HIV has a
examinations, routine pathology would not be cost effective. 1 direct effect on oncogenes and inactivates tumour-suppressor
genes; it may even cause more susceptibility to the effects of
The palatine tonsils play an important role in immunologic the co-existing viral infections. It has been shown that cells
surveillance and resistance to infection in the upper aero involved in the immune system of HIV-positive patients
digestive tract. Palatine tonsils taken from individuals have a shortening of the telomeres. This may indicate that
10
infected with HIV-1 have shown infected lymphocytes HIV-positive patients have a more rapid rate of immunologic
localised to the surface of the tonsillar crypt epithelium. ageing predisposing to malignancy. 10,11
Thus, HIV may replicate rapidly at this site because of the
numerous T-cells and dendritic cells present. HIV is rarely Materials and methods
transferred through the oral cavity and oropharynx as long
as the mucosa is intact as demonstrated by a laboratory We reviewed our departmental theatre registries and identified
experiment, whereby minimal transfer of HIV was found 319 patients with tonsillar histopathology. The surgical
after human tonsillar tissue was bathed in HIV semen with procedures were performed between 01 July 2005 and 30 June
an intact mucosa. 7 2015 at the Chris Hani Baragwanath Hospital, Charlotte
Maxeke Johannesburg Academic Hospital and Helen Joseph
HIV infection is associated with an increased risk of a range hospitals, Johannesburg, South Africa. These are teaching
of malignancies given as follows: hospitals affiliated to the University of the Witwatersrand.
The patients’ histology and laboratory records were collected
• Acquired immunodeficiency syndrome (AIDS) defining from the National Health Care Laboratory database.
(virus-related):
ß Kaposi sarcoma (KS). In our cohort, we included adult patients with known HIV
ß Non-Hodgkin’s lymphoma (NHL). serostatus, and 160 patients were identified.
ß Cervical cancer.
• Non-AIDS defining carcinomas (NADC): In addition, we recorded other factors, including age, CD4
ß Lung. count and histology result. We did not record clinical data
ß Liver. because of incomplete medical records.
ß Anal.
ß Tonsillar. 8 Ethical consideration

In the case of tonsillar malignancies, co-infection with human Ethics approval was obtained in March 2016 from the
papilloma virus (HPV) is thought to be responsible for the University of the Witwatersrand (Ethical Clearance number:
increase, but HIV itself may play a role. 8 M151140).

KS is a frequently reported mesenchymal neoplasm Results
characterised by neoangiogenesis and endothelial-derived, There were 160 patients in our cohort. All the statistical tests
spindle-shaped tumour cells in HIV-infected people, and it is were carried out with a 5% significance level. All the analyses
caused by human herpes virus 8 (HHV8). KS is usually isolated were carried out using the Statistical Packages for Social
to the skin and oral mucosa although it may also occur in the Sciences version 1.
lungs, liver, stomach, bowel and lymph nodes. It has also been
described in multiple mucosal sites, including the pharynx,
larynx, nasal cavity, oral cavity and the palatine tonsil. 9 Ages of patients
The ages of the patients in the study range from 18 to 77 years
Lymphomas are the most common malignancy in HIV- old, with a mean age of 35 years. In the HIV-positive group,
infected individuals. They represent more than 50% of AIDS- the mean age was 32.5 years and the range was 19–66 years.
related malignancies. HIV-associated lymphomas are In the HIV-negative group, the mean age was 34 years and
usually: the range was 18–77 years.
• high grade
• clinically advanced at presentation Figure 1 indicates the distribution of tonsillar histopathology
• associated with extra nodal disease. results in HIV-infected and HIV-uninfected patients in red

http://www.sajhivmed.org.za 239 Open Access