Page 248 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 5 Original Research

8
with HIV (11.6%) and without HIV (10.8%). The presence of carcinoma in their review of 5924 HIV-infected patients.
actinomycosis infection in tonsillectomy specimens is well Mitsuyasu reviewed the incidence of both AIDS-defining
described. Rebechi et al. evaluated the routine histopathology and NADC in the United States. He did not find an increased
of 281 patients who underwent tonsillectomy, most of whom incidence of tonsillar malignancies. Grulich et al.
11
had recurrent bouts of infection. They found evidence of performed a meta-analysis of people with HIV/AIDS
chronic tonsillitis with colonies of actinomyces in 9.6% of (444 172 patients). They found an increased incidence of
18
their patients. In light of our findings, we concur with oral cavity and pharyngeal tumours. Unfortunately, they
Hasan et al., who suggested that actinomycosis is likely to did not specify whether any of their patients had tonsillar
have a causal association with recurrent tonsillitis and malignancies. 23
tonsillar hypertrophy. 17
In our study, KS was detected in seven patients, all of whom
South Africa has one of the highest burdens of TB in the were HIV-infected. There is an established strong correlation
world, with an estimated 450 000 active cases in 2013. We, between HIV and KS, which has been borne out of the
19
however, did not detect any evidence of TB in the specimens literature. 8,11,24,25 HIV-infected individuals in southern Africa
that we reviewed. This is not unexpected as tonsillar have a higher risk of developing KS than their counterparts
involvement in TB infection is rare. Ricciardello et al. looked in Europe. Prior to the HIV epidemic, the prevalence of KS
24
at otorhinolaryngology-related TB in 304 patients. Their was low in Africa. There has been a marked surge in the
study was conducted in Naples. They found tonsillar number of KS cases. HHV8 is implicated in this resurgence
involvement in only two patients. 20 of KS. The mechanism of how HHV8 causes KS is not
completely understood, but it is believed to be instigated by
SCC is the most common malignancy in patients with non- oncoprotein production and the inhibition of tumour-
benign tonsillar lesions. It accounts for up to 7% of suppressor genes. It usually begins in the head and neck.
malignancies. Courville et al. tested 1093 adult patients, and This may be because of the fact that the oropharynx is the
of these, 75 (7%) had SCC. Malignancies were suspected main reservoir for HHV8. 25
21
prior to the confirmatory histology in all of their patients.
Four of our patients had SCC on pathological evaluation; Franzetti et al. found a significant association between
three patients were HIV-uninfected and one patient had HIV NADC and low CD4 counts (< 200 cells/mm ). They
3
infection. Randall et al. found 22 patients with SCC (0.04%). evaluated 5924 HIV-infected patients over a 26-year period.
The relatively low overall prevalence in their study was They used regression models to compare the cancer risk in
probably because of the high number of paediatric their HIV-infected patients to age- and gender-matched
tonsillectomy specimens (96%). In their adult population, individuals. We could not confirm this relationship. We
8
SCC was present in 25 patients (1.2%). 22 cannot exclude the possibility that the retrospective nature
of our study, the relatively small number of events and the
Lymphomatous lesions are well described in patients with large deviations of CD4 counts would make our results less
tonsillar malignancy. Their occurrence ranges from 0% to reliable. Advancing age was the only predictor of
1.74%. 1,13,14,15,21,22 Ikram et al. studied 200 patients between the malignancy in both the HIV-infected and HIV-uninfected
ages of 4 and 49 years. They detected lymphoma in only one subgroups.
patient (0.5%). Younis et al. evaluated the histopathology in
13
2438 routine tonsillectomy specimens. In the 339 adult Study limitations
specimens they reviewed, they detected lymphoma in six
patients (1.74%). All their lymphoma patients had suspicious The size of our study cohorts may be adequate, but is not
clinical findings preoperatively. We had four patients (1.3%) ideal for a statistically powerful analysis. Unfortunately,
14
with lymphoma; one of these patients had concomitant HIV many patients were excluded because of the absence of HIV
infection. results.
The lack of clinical data on the patients is not ideal as we
The relationship between tonsillar malignancies and
underlying HIV is not well established. We found 14 patients were unable to establish the absence or presence of established
with malignancies, and of those patients, eight were HIV- high-risk features.
infected and six were HIV-uninfected. The results showed no
significant correlation between tonsil malignancy and HIV The significance of our study lies in the findings that
infection. advancing age may be an additional risk factor to consider,
and HIV status does not confer an added risk in the
development of tonsillar malignancies.
HIV infection is associated with an increased risk of a range
of cancers, including KS, NHL and cervical cancer, which Conclusion
are considered virus-related and AIDS-defining diseases.
The spectrum and incidence of NADC (smoking- and virus- Our study findings are consistent with current
related) has also been shown to be augmented. Franzetti et recommendations that there is inadequate proof for routine
al. found a higher than expected incidence of tonsil histological examinations from patients who do not exhibit

http://www.sajhivmed.org.za 241 Open Access