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  • Review Article
  • Published:

Urological aspects of HIV and AIDS

Nature Reviews Urology volume 10, pages 713–722 (2013)Cite this article

Subjects

Key Points

  • Since the introduction of antiretroviral therapy (ART), there has been a dramatic decrease in the incidence of opportunistic infections and HIV-related malignancies (except cervical carcinoma)

  • Advanced cervical carcinoma is associated with a high incidence of urological complications such as hydronephrosis, renal failure, and vesicovaginal fistula

  • HIV-infected patients who are compliant with a regimen of ART have an average life expectancy of >20 years

  • Patients on ART with renal failure, erectile dysfunction, infertility, and malignancies should receive the same treatment as HIV-negative patients

  • The urologist is increasingly likely to perform procedures in HIV-positive patients on ART who have the same urological conditions as the general population

  • Surgical outcomes in patients with a CD4 count of >200 cells/μl or blood viral load of <10,000 copies/ml are similar to those of the general population

Abstract

The use of highly active antiretroviral therapy (HAART) in HIV-infected people has led to a dramatic decrease in the incidence of opportunistic infections and virus-related malignancies such as non-Hodgkin lymphoma and Kaposi sarcoma, but not cervical or anal cancer. Advanced-stage cervical cancer is associated with a high incidence of urological complications such as hydronephrosis, renal failure, and vesicovaginal fistula. Adult male circumcison can significantly reduce the risk of male HIV acquisition. Although HAART does not completely eradicate HIV, compliance with medication increases life expectancy. HIV infection or treatment can result in renal failure, which can be managed with dialysis and transplantation (as for HIV-negative patients). Although treatment for erectile dysfunction—including phosphodiesterase 5 inhibitors, intracavernosal injection therapy, and penile prosthesis—can increase the risk of HIV transmission, treatment decisions for men with erectile dysfunction should not be determined by HIV status. The challenges faced when administering chemotherapy to HIV-infected patients with cancer include late presentation, immunodeficiency, drug interactions, and adverse effects associated with compounded medications. Nonetheless, HIV-infected patients should receive the same cancer treatment as HIV-negative patients. The urologist is increasingly likely to encounter HIV-positive patients who present with the same urological problems as the general population, because HAART confers a prolonged life expectancy. Performing surgery in an HIV-infected individual raises safety issues for both the patient (if severely immunocompromised) and the surgeon, but the risk of HIV transmission from patients on fully suppressive HAART is small.

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Figure 1: Infection with herpes vegetans.
Figure 2: Complications of infection with tuberculosis.
Figure 3: Penile infection with tuberculosis.
Figure 4: Scrotal swelling with disseminated lymphoma.
Figure 5: Persisting nonhealing ulcers.

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Authors and Affiliations

  1. Department of Urology, Stellenbosch University and Tygerberg Hospital, Faculty of Medicine and Health Sciences, PO Box 19063, Tygerberg, 7505, South Africa

    Chris F. Heyns, Shaun G. Smit, André van der Merwe & Amir D. Zarrabi

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  1. Chris F. Heyns
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Contributions

C. F. Heyns researched, wrote, edited, and discussed this article with colleagues. S. G. Smit, A. van der Merwe, and A. D. Zarrabi reviewed and edited this manuscript before submission. A. D. Zarrabi also made substantial contributions towards discussions of content.

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Correspondence to Chris F. Heyns.

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Heyns, C., Smit, S., van der Merwe, A. et al. Urological aspects of HIV and AIDS. Nat Rev Urol 10, 713–722 (2013). https://doi.org/10.1038/nrurol.2013.230

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