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constituyendo los TNDS la principal causa de muerte<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El conjunto de las neoplasias que presentan los pacientes VIH se divide en 2 grupos&#58; las asociadas al VIH y las no asociadas al VIH &#40;algunas de las cuales se relacionan con otras enfermedades virales&#41;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">8-16</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Dentro de las asociadas al VIH se incluyen&#58; 1&#41; el sarcoma de Kaposi&#44; relacionado con el virus herpes humano tipo<span class="elsevierStyleHsp" style=""></span>8 &#40;VHH-8&#41;&#59; 2&#41; los linfomas no Hodgkin&#44; relacionados con el virus de Epstein Barr &#40;VEB&#41;&#59; y 3&#41; el carcinoma de c&#233;rvix&#44; relacionado con el virus del papiloma humano &#40;VPH&#41;&#46; Entre las enfermedades tumorales independientes de la infecci&#243;n VIH y relacionadas con enfermedades virales destacan el linfoma de Hodgkin &#40;LH&#41;&#44; relacionado con el VEB&#59; el carcinoma del canal anal&#44; relacionado con el VPH&#59; y el hepatocarcinoma&#44; asociado con los virus de las hepatitis<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">C</span> &#40;VHC&#41; y B &#40;VHB&#41;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">17</span></a>&#46; Shepherd et al&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">18</span></a> propusieron que la clasificaci&#243;n de las neoplasias se base en su relaci&#243;n o no con infecciones virales&#46; Las enfermedades tumorales sin implicaci&#243;n viral est&#225;n representadas fundamentalmente por el carcinoma de pulm&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Recientemente&#44; hemos revisado las enfermedades tumorales en 4&#46;994 pacientes VIH atendidos en nuestro centro desde 1986 hasta 2016&#46; Se diagnostic&#243; al menos un tumor en 416 pacientes &#40;8&#44;3&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">19&#44;20</span></a>&#46; En nuestra experiencia&#44; a medida que se ha generalizado el uso de tratamiento antirretroviral &#40;TAR&#41;&#44; la incidencia de los tumores diagn&#243;sticos de sida &#40;TDS&#41; ha ido disminuyendo&#44; mientras que la de los TNDS ha aumentado<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Etiopatogenia</span><p id="par0020" class="elsevierStylePara elsevierViewall">El origen de las enfermedades tumorales en los pacientes con infecci&#243;n por el VIH es multifactorial&#44; siendo los factores m&#225;s importantes el propio VIH&#44; la inmunodepresi&#243;n&#44; la coinfecci&#243;n con virus oncog&#233;nicos y la mayor supervivencia debida al uso de TAR<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">21-24</span></a>&#46; El VIH es una condici&#243;n necesaria&#44; pero no suficiente&#44; ya que no es un virus oncog&#233;nico&#46; Sin embargo&#44; su presencia condiciona una situaci&#243;n de inmunodepresi&#243;n cr&#243;nica que est&#225; relacionada con los TDS<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">21&#44;25</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La alteraci&#243;n de la inmunidad y la viremia VIH no controlada aumentan el riesgo de desarrollar neoplasias&#44; de tal forma que una carga viral indetectable y unos linfocitos CD4&#43; superiores a 500&#47;mm<span class="elsevierStyleSup">3</span> son factores que protegen del desarrollo de algunos tumores&#44; fundamentalmente los TDS&#46; Sin embargo&#44; coincidiendo con la introducci&#243;n de pautas de TAR de alta eficacia se ha producido un aumento de los TNDS ya que&#44; aunque la situaci&#243;n inmunol&#243;gica mejora&#44; no se restaura completamente<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">26-29</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La influencia de la TAR en la aparici&#243;n de tumores es independiente del f&#225;rmaco utilizado&#44; 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particularmente el VPH&#44; relacionado con el carcinoma de c&#233;rvix&#44; del canal anal y del &#225;rea otorrinolaringol&#243;gica&#46; Otros virus oncog&#233;nicos son los ya mencionados virus hepatotropos&#44; el VEB y el VHH-8<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">18&#44;34&#44;35</span></a>&#46; Finalmente&#44; el incremento de la supervivencia es uno de los factores que m&#225;s ha influido en el aumento de las enfermedades neopl&#225;sicas de esta poblaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0575"><span class="elsevierStyleSup">36&#44;37</span></a>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Tumores no diagn&#243;sticos de sida</span><p id="par0040" class="elsevierStylePara elsevierViewall">Constituyen un grupo de neoplasias muy heterog&#233;neo que var&#237;a dependiendo del &#225;rea geogr&#225;fica considerada&#46; Generalmente aparecen en pacientes j&#243;venes y su presentaci&#243;n es at&#237;pica&#44; con grandes masas tumorales que pueden progresar r&#225;pidamente a pesar del tratamiento<a class="elsevierStyleCrossRefs" href="#bib0585"><span class="elsevierStyleSup">38-42</span></a>&#46; Este no difiere del utilizado en la poblaci&#243;n general&#44; aunque su administraci&#243;n puede ser m&#225;s compleja por las interacciones medicamentosas y las comorbilidades asociadas<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a>&#46; Estas caracter&#237;sticas determinan que la mortalidad sea siempre mayor en la poblaci&#243;n con infecci&#243;n por VIH<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">44&#44;45</span></a>&#46; En el momento actual&#44; el pron&#243;stico global de los TNDS es peor que el de los TDS&#46; En un estudio multic&#233;ntrico italiano&#44; en el que se analizaba la mortalidad de los pacientes con infecci&#243;n por VIH diagnosticados de una neoplasia&#44; se observ&#243; que solo el 45&#37; de los que ten&#237;an un TNDS viv&#237;an a los 10 a&#241;os frente al 60&#37; de los que padec&#237;an un TDS<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">46</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Los TNDS m&#225;s frecuentes relacionados con virus son el del canal anal&#44; el LH y el hepatocarcinoma&#59; mientras que en relaci&#243;n con el h&#225;bito tab&#225;quico destaca el carcinoma de pulm&#243;n&#46; Otros tumores frecuentes en la poblaci&#243;n general&#44; como los carcinomas de mama&#44; pr&#243;stata o colon&#44; no tienen una incidencia mayor en los pacientes VIH&#44; y su comportamiento evolutivo es similar<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">25&#44;47</span></a>&#46; No obstante&#44; el carcinoma de mama es incluso menos frecuente en las mujeres con VIH&#44; pero suele ser m&#225;s agresivo<a class="elsevierStyleCrossRefs" href="#bib0635"><span class="elsevierStyleSup">48&#44;49</span></a>&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Linfoma de Hodgkin</span><p id="par0050" class="elsevierStylePara elsevierViewall">El LH es uno de los TNDS m&#225;s frecuentes y tiene una incidencia entre 15 y 30 veces superior a la de la poblaci&#243;n general&#46; Los enfermos con LH no presentan una inmunodepresi&#243;n profunda&#44; y en algunas series su incidencia es mayor a medida que se incrementa el recuento de linfocitos CD4&#43;<a class="elsevierStyleCrossRefs" href="#bib0645"><span class="elsevierStyleSup">50&#44;51</span></a>&#46; Para explicar este hallazgo se ha especulado que existe una posible interrelaci&#243;n entre las c&#233;lulas de Reed-Sternberg y los linfocitos CD4&#43; que las rodean&#46; En este sentido las c&#233;lulas de Reed-Sternberg&#44; productoras de citocinas&#44; atraen CD4&#43; y otras c&#233;lulas inflamatorias a su alrededor&#46; Como consecuencia de ello&#44; estos CD4&#43; se activar&#237;an y proporcionar&#237;an las se&#241;ales necesarias para la proliferaci&#243;n y la supervivencia de las c&#233;lulas malignas&#44; que ser&#237;a m&#225;s acusada en los pacientes con un mayor recuento de linfocitos CD4&#43;<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">52</span></a>&#46; En la mayor&#237;a de las ocasiones los LH en los pacientes VIH&#43; se presentan en estadio<span class="elsevierStyleHsp" style=""></span>IVB&#44; y el tratamiento no difiere del empleado en los pacientes VIH negativos&#46; Al igual que en cualquier otro tipo de tumor&#44; el uso de la TAR y la profilaxis de las infecciones oportunistas son parte esencial del tratamiento<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">3&#44;43&#44;53</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En los pacientes con infecci&#243;n por VIH&#44; la supervivencia del LH est&#225; condicionada por los factores pron&#243;sticos asociados al tumor&#44; pero la TAR tiene tambi&#233;n una importancia primordial&#46; En un estudio multic&#233;ntrico espa&#241;ol<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">54</span></a>&#44; la supervivencia global de estos pacientes a los 10 a&#241;os fue del 60&#37;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Hepatocarcinoma</span><p id="par0060" class="elsevierStylePara elsevierViewall">Su incidencia en la poblaci&#243;n con infecci&#243;n por VIH es 8 veces mayor que la de la poblaci&#243;n general&#44; aunque su etiopatogenia y comportamiento evolutivo no difieren significativamente entre ambas poblaciones<a class="elsevierStyleCrossRefs" href="#bib0670"><span class="elsevierStyleSup">55-57</span></a>&#46; Los factores implicados en su desarrollo son la hepatitis cr&#243;nica viral &#40;sobre todo la hepatitis<span class="elsevierStyleHsp" style=""></span>C en nuestro medio&#41;&#44; la cirrosis de cualquier etiolog&#237;a y el consumo de alcohol&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La principal y posiblemente &#250;nica medida de prevenci&#243;n es el tratamiento del VHC&#44; pero la reducci&#243;n del riesgo en los pacientes con respuesta sostenida al tratamiento antiviral no es absoluta&#44; por lo que hay que continuar con las estrategias de cribado aunque se haya curado la infecci&#243;n por VHC<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">58</span></a>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Carcinoma del canal anal</span><p id="par0070" class="elsevierStylePara elsevierViewall">El carcinoma del canal anal est&#225; estrechamente relacionado con los genotipos oncog&#233;nicos del VPH&#44; que se detectan en m&#225;s del 90&#37; de los casos&#46; Mientras su incidencia en la poblaci&#243;n con infecci&#243;n por VIH es de 55-144&#47;100&#46;000 pacientes&#47;a&#241;o&#44; en la poblaci&#243;n general es tan solo de 1-1&#44;5&#47;100&#46;000 pacientes&#47;a&#241;o<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">59</span></a>&#46; El mayor riesgo lo tienen los varones homosexuales&#44; pero tambi&#233;n se diagnostica en mujeres que tienen sexo anal y en pacientes con verrugas genitales<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">59</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Como medidas principales de prevenci&#243;n se recomiendan el uso de preservativo &#40;aunque no protege en el 100&#37; de los casos&#41; y de la vacuna&#44; cuya eficacia est&#225; ya contrastada en mujeres para prevenir el carcinoma de c&#233;rvix<a class="elsevierStyleCrossRefs" href="#bib0695"><span class="elsevierStyleSup">60&#44;61</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Seg&#250;n las recomendaciones del grupo de estudio del sida &#40;GESIDA&#41; de la Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica&#44; para el diagn&#243;stico precoz se debe realizar una citolog&#237;a anal a los pacientes de riesgo&#44; independientemente de la presencia o no del VPH<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Carcinoma pulmonar</span><p id="par0085" class="elsevierStylePara elsevierViewall">Es el tumor m&#225;s frecuente tanto en la poblaci&#243;n con infecci&#243;n por VIH como en la poblaci&#243;n general&#44; y tiene una estrecha relaci&#243;n con el consumo de tabaco&#46; Sin embargo&#44; en los pacientes con infecci&#243;n por VIH&#44; independientemente del h&#225;bito tab&#225;quico&#44; se ha observado que es 2-4 veces m&#225;s frecuente&#44; aparece en edades m&#225;s tempranas&#44; su comportamiento es m&#225;s agresivo y su pron&#243;stico&#44; peor<a class="elsevierStyleCrossRefs" href="#bib0705"><span class="elsevierStyleSup">62-65</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">El c&#225;ncer de pulm&#243;n es una de las principales causas de muerte&#44; pero hasta hace poco no ha habido un m&#233;todo de despistaje que permitiera realizar un diagn&#243;stico precoz&#46; En la actualidad&#44; a ra&#237;z de la publicaci&#243;n de los datos del <span class="elsevierStyleItalic">National Lung Screening Trial</span> en 2013<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">66</span></a>&#44; se propone el uso de la tomograf&#237;a computarizada de baja radiaci&#243;n&#44; en la poblaci&#243;n de riesgo no VIH&#44; ya que ha demostrado ser &#250;til en el diagn&#243;stico precoz de este tumor&#44; aunque a&#250;n se est&#225; evaluando su coste-efectividad&#46; En la poblaci&#243;n con infecci&#243;n por VIH este aspecto est&#225; poco estudiado y por ello GESIDA est&#225; llevando a cabo un estudio multic&#233;ntrico para valorar la eficacia de esta medida &#40;GESIDA 8815&#41;<a class="elsevierStyleCrossRef" href="#bib0730"><span class="elsevierStyleSup">67</span></a>&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Tratamiento de los tumores no diagn&#243;sticos de sida</span><p id="par0095" class="elsevierStylePara elsevierViewall">El tratamiento de los TNDS&#44; al igual que el de los TDS&#44; est&#225; basado en 3 pilares fundamentales<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">44&#44;68-70</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0100" class="elsevierStylePara elsevierViewall">El tratamiento antineopl&#225;sico debe ser igual al empleado en los pacientes VIH negativos&#46; Si no se tiene en cuenta esta premisa&#44; la mortalidad se puede incrementar ya que se realizar&#237;an terapias inadecuadas<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">71</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Se debe iniciar precozmente el tratamiento de la infecci&#243;n por VIH con una TAR eficaz&#44; segura y con pocas interacciones medicamentosas<a class="elsevierStyleCrossRefs" href="#bib0755"><span class="elsevierStyleSup">72-74</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0110" class="elsevierStylePara elsevierViewall">La profilaxis y tratamiento de las infecciones oportunistas constituye una medida esencial&#46; Se realizar&#225; tanto en aquellas infecciones directamente relacionadas con la inmunodepresi&#243;n como en aquellas que&#44; como la tuberculosis&#44; tienen una incidencia elevada en nuestro medio&#46; Debe tenerse en cuenta que tras el empleo de quimio o radioterapia se produce un descenso de la cifra total de linfocitos CD4 en un 30-50&#37;&#44; con respecto a la basal&#44; no recuper&#225;ndose los niveles pretratamiento hasta pasados 6-12 meses<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">75</span></a>&#46; Por ello&#44; se recomienda realizar profilaxis con cotrimoxazol siempre&#44; aunque al inicio del tratamiento los linfocitos CD4&#43; sean superiores a 200&#47;mm<span class="elsevierStyleSup">3</span>&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Diagn&#243;stico precoz y prevenci&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">En lo que se refiere a las medidas destinadas al diagn&#243;stico precoz de las neoplasias&#44; en ninguna de las gu&#237;as de TAR&#44; excepto en las de la <span class="elsevierStyleItalic">European AIDS Clinical Society</span><a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">76</span></a>&#44; se hace referencia expresa a este punto&#46; En nuestro pa&#237;s&#44; GESIDA ha elaborado un documento&#44; redactado de forma independiente de las gu&#237;as de TAR&#44; sobre el manejo de los TNDS en el que se contemplan tanto la prevenci&#243;n como el diagn&#243;stico precoz<span class="elsevierStyleBold">&#44;</span> que b&#225;sicamente no difieren de lo recomendado para la poblaci&#243;n general &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a>&#46; De acuerdo con el mismo&#44; las medidas de prevenci&#243;n m&#225;s importantes y de eficacia contrastada son&#58; el desarrollo de h&#225;bitos de vida saludable &#40;disminuci&#243;n del consumo de alcohol y tabaco&#41;&#44; el tratamiento del VHC&#44; y el empleo de vacunas frente al VPH y&#44; en menor medida&#44; frente al VHB<a class="elsevierStyleCrossRefs" href="#bib0610"><span class="elsevierStyleSup">43&#44;57&#44;58&#44;60&#44;61&#44;77-79</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusiones</span><p id="par0120" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#46;</span><p id="par0125" class="elsevierStylePara elsevierViewall">La mayor&#237;a de las neoplasias&#44; tanto TDS como TNDS&#44; que aparecen en los pacientes con infecci&#243;n por VIH est&#225;n relacionadas con infecciones virales&#46; Los TNDS presentan una frecuencia y gravedad mayores que los TDS&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#46;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Una carga viral &#40;VIH&#41; indetectable y unos linfocitos CD4&#43; superiores a 500&#47;mm<span class="elsevierStyleSup">3</span> son factores que protegen del desarrollo de algunos tumores&#44; fundamentalmente de TDS&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#46;</span><p id="par0135" class="elsevierStylePara elsevierViewall">El tratamiento de las neoplasias en sujetos VIH se asemeja al empleado en la poblaci&#243;n general&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4&#46;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Se debe realizar profilaxis de las infecciones oportunistas mientras se administra quimioterapia&#44; aunque los CD4 sean superiores a 200&#47;mm<span class="elsevierStyleSup">3</span>&#46;</p></li></ul></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicto de intereses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Desde los inicios de la epidemia del virus de la inmunodeficiencia humana &#40;VIH&#41;&#44; la patolog&#237;a tumoral ha sido muy importante&#46; El conjunto de las neoplasias se puede dividir b&#225;sicamente en 2 grupos&#58; las asociadas al VIH&#44; todas ellas relacionadas con enfermedades virales&#44; y las no asociadas al VIH&#44; entre las que algunas est&#225;n asociadas a enfermedades virales y otras no&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El origen es multifactorial y las principales causas que han llevado a que se produzca un aumento de la patolog&#237;a tumoral son la inmunodepresi&#243;n&#44; la coinfecci&#243;n con virus oncog&#233;nicos y la prolongaci&#243;n de la vida secundaria al uso de tratamiento antirretroviral&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Establecer las caracter&#237;sticas generales de los tumores no diagn&#243;sticos de sida es dif&#237;cil fundamentalmente porque son un grupo muy heterog&#233;neo formado por neoplasias de diversa &#237;ndole&#46; Los tratamientos no difieren de los empleados en la poblaci&#243;n general&#44; aunque el manejo puede ser m&#225;s dif&#237;cil por el diagn&#243;stico tard&#237;o&#44; las interacciones medicamentosas y las comorbilidades asociadas&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Since the start of the human immunodeficiency virus &#40;HIV&#41; epidemic&#44; tumour disease among patients has been significant&#46; The collection of malignancies can be divided primarily into 2 groups&#58; those associated with HIV &#40;all of which are related to viral diseases&#41; and those not associated with HIV &#40;only some of which are associated with viral diseases&#41;&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The origin of these malignancies is multifactorial&#44; and the main causes that have led to an increase in tumour disease are immunosuppression&#44; coinfection with oncogenic viruses and life prolongation secondary to the use of antiretroviral therapy&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Establishing the general characteristics of the undiagnosed AIDS tumours is difficult&#44; mainly because they are a highly heterogeneous group formed by malignancies of a diverse nature&#46; The treatments do not differ from those used in the general population&#44; although the management can be more difficult due to the late diagnosis&#44; drug interactions and associated comorbidities&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Algoritmo para el diagn&#243;stico precoz del carcinoma del canal anal&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ASCUS&#58; c&#233;lulas de significado incierto&#59; SIL&#58; lesi&#243;n intraepitelial&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Fuente&#58; adaptaci&#243;n de Santos&#44; Valencia y Panel de expertos de GeSIDA<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a>&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> En estos 3 tumores las medidas recomendadas para el diagn&#243;stico precoz no difieren de las empleadas en la poblaci&#243;n general&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">HSH&#58; hombres que tienen sexo con hombres&#59; PSA&#58; ant&#237;geno prost&#225;tico espec&#237;fico&#59; TC&#58; tomograf&#237;a computarizada&#59; VHB&#58; virus de la hepatitis<span class="elsevierStyleHsp" style=""></span>B&#59; VHC&#58; virus de la hepatitis<span class="elsevierStyleHsp" style=""></span>C&#59; VPH&#58; virus del papiloma humano&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pacientes cirr&#243;ticos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pacientes fumadores mayores de 45 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TC de t&#243;rax baja radiaci&#243;n sin administraci&#243;n de contraste&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carcinoma de colon<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Personas entre 50 y 75 a&#241;os&#46; Antecedentes familiares de c&#225;ncer de colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sangre oculta en heces anual &#177; colonoscopia cada 5 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carcinoma de pr&#243;stata<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tacto rectal &#177; PSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carcinoma de mama<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mujeres entre 50 y 70 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mamograf&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                0 => array:2 [
                  "contribucion" => array:1 [
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Vol. 218. Núm. 3.
Páginas 149-155 (abril 2018)
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Vol. 218. Núm. 3.
Páginas 149-155 (abril 2018)
Revisión
Neoplasias e infección por el virus de la inmunodeficiencia humana: ¿enfermedades emergentes?
Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases?
Visitas
101
M.E. Valencia Ortega
Servicio de Medicina Interna-Unidad de VIH, Hospital Universitario La Paz, Madrid, España
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Tabla 1. Medidas destinadas a la prevención y al diagnóstico precoz de algunas de las neoplasias diagnosticadas en los pacientes con infección por el virus de la inmunodeficiencia humana
Resumen

Desde los inicios de la epidemia del virus de la inmunodeficiencia humana (VIH), la patología tumoral ha sido muy importante. El conjunto de las neoplasias se puede dividir básicamente en 2 grupos: las asociadas al VIH, todas ellas relacionadas con enfermedades virales, y las no asociadas al VIH, entre las que algunas están asociadas a enfermedades virales y otras no.

El origen es multifactorial y las principales causas que han llevado a que se produzca un aumento de la patología tumoral son la inmunodepresión, la coinfección con virus oncogénicos y la prolongación de la vida secundaria al uso de tratamiento antirretroviral.

Establecer las características generales de los tumores no diagnósticos de sida es difícil fundamentalmente porque son un grupo muy heterogéneo formado por neoplasias de diversa índole. Los tratamientos no difieren de los empleados en la población general, aunque el manejo puede ser más difícil por el diagnóstico tardío, las interacciones medicamentosas y las comorbilidades asociadas.

Palabras clave:
Tumores no diagnósticos de sida
Neoplasias y VIH
Mortalidad
Abstract

Since the start of the human immunodeficiency virus (HIV) epidemic, tumour disease among patients has been significant. The collection of malignancies can be divided primarily into 2 groups: those associated with HIV (all of which are related to viral diseases) and those not associated with HIV (only some of which are associated with viral diseases).

The origin of these malignancies is multifactorial, and the main causes that have led to an increase in tumour disease are immunosuppression, coinfection with oncogenic viruses and life prolongation secondary to the use of antiretroviral therapy.

Establishing the general characteristics of the undiagnosed AIDS tumours is difficult, mainly because they are a highly heterogeneous group formed by malignancies of a diverse nature. The treatments do not differ from those used in the general population, although the management can be more difficult due to the late diagnosis, drug interactions and associated comorbidities.

Keywords:
Undiagnosed AIDS tumours
Malignancies and HIV
Mortality

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