Anoperineal tuberculosis: diagnostic and management considerations in seven cases.

PURPOSE: Anoperineal tuberculosis is a rare extrapulmonary form of the disease that we must learn to recognize because it requires specific treatment. METHODS: Data from seven patients with anoperineal tuberculosis observed in a Parisian proctology unit between 1982 and 1999 were reviewed. RESULTS: All the patients were male (median age, 55 years); five were born in underdeveloped countries, and two were still living there. The average length of time between first manifestation of the disease and diagnosis was three years (range, 3 months to 9 years); all patients had undergone surgery previously. There were six recurring anal fistulas (complex in 5 cases) and one recurring abscess. In every case, the diagnosis had been suspected or confirmed by systematic histologic study of the surgically excised tissue. An association with pulmonary tuberculosis was found in each case. Treatment included two parts: conventional surgical treatment of anal sepsis and specific medical antituberculosis treatment. Evolution was favorable in all cases, with no recurrence of disease. Human immunodeficiency virus infection did not increase the incidence of anoperineal tuberculosis. CONCLUSION: Tuberculosis should be suspected in all recurrent fistulas. Histologic examination of the excised tissue and a lung x-ray should be performed to avoid delay in diagnosing an easily curable disease.

Liver fibrosis progression in human immunodeficiency virus and hepatitis C virus coinfected patients. The Multivirc Group.

The natural history of hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-infected patients has never been studied according to the concept of liver fibrosis progression. The aim of this work was to assess the fibrosis progression rate in HIV-HCV coinfected patients and in patients infected by HCV only. A cohort of 122 HIV-HCV coinfected patients was compared with a control group of 122 HIV-negative HCV-infected patients. Groups were matched according to age, sex, daily alcohol consumption, age at HCV infection, and duration and route of HCV infection. The fibrosis progression rate was defined as the ratio between fibrosis stage (METAVIR scoring system) and the HCV duration. The prevalence of extensive liver fibrosis (METAVIR fibrosis scores 2, 3, and 4) and moderate or severe activity were higher in HIV-infected patients (60% and 54%, respectively) than in control patients (47% and 30%, respectively; P <.05 and P <.001, respectively). The median fibrosis progression rate in coinfected patients and in control patients was 0.153 (95% confidence interval [CI], 0.117-0.181) and 0.106 (95% CI, 0.084-0.125) fibrosis units per year, respectively (P <.0001). HIV seropositivity (P <.0001), alcohol consumption (>50 g/d, P =.0002), age at HCV infection (<25 years old, P <.0001), and severe immunosuppression (CD4 count 50 g/d), CD4 count (