AIDS-related malignancies: Changing epidemiology and the impact of highly active antiretroviral therapy
ABSTRACT Three cancers in people with HIV denote an AIDS diagnosis: Kaposi's sarcoma, high-grade B-cell non-Hodgkin's lymphoma and invasive cervical cancer. In addition a number of other cancers occur at increased frequency in this population group but are not AIDS-defining illnesses. This review discusses the impact of highly active antiretroviral therapy on the epidemiology and outcome of AIDS-defining cancers.
The incidence of both Kaposi's sarcoma and non-Hodgkin's lymphoma has declined in the era of highly active antiretroviral therapy and the outcome of both tumours has improved. Moreover, highly active antiretroviral therapy alone produces a response in a majority of antiretroviral-naïve patients with Kaposi's sarcoma. In contrast, highly active antiretroviral therapy has had little impact on the incidence of human papilloma virus-associated tumours (cervical and anal cancer) in people with HIV, although it may improve survival by reducing opportunistic infection deaths. As people with HIV live longer with highly active antiretroviral therapy, an increased incidence of other non AIDS-defining cancers that have no known association with oncogenic infections is becoming apparent.
For those with access to highly active antiretroviral therapy, the good news from the AIDS-defining cancers - particularly Kaposi's sarcoma and non-Hodgkin's lymphoma - may be balanced by the increasing numbers of non AIDS-defining cancers.
- SourceAvailable from: Ricardo Ney Cobucci
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- "In addition to life expectancy, the therapy also affected the epidemiology of non-AIDS-defining cancers (NADCs) and has an important impact on the evolution of these tumors . Before HAART, cancers were responsible for less than 10% of deaths among HIV-infected patients . After HAART, 28% of deaths in this population have been attributed to neoplastic causes , despite the substantial decline in the risk of acquiring AIDS-defining cancers (ADCs), especially Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL) . "
ABSTRACT: After highly active antiretroviral therapy (HAART) became widespread, several studies demonstrated changes in the incidence of defining and non-defining AIDS cancers among HIV/AIDS patients. We conducted a systematic review of observational studies evaluating the incidence of malignancies before and after the introduction of HAART in people with HIV/AIDS. Eligible studies were searched up to December 2012 in the following databases: Pubmed, Embase, Scielo, Cancerlit and Google Scholar. In this study, we determined the cancer risk ratio by comparing the pre- and post-HAART eras. Twenty-one relevant articles were found, involving more than 600,000 people with HIV/AIDS and 10,891 new cases of cancers. The risk for the development of an AIDS-defining cancer decreased after the introduction of HAART: Kaposi's sarcoma (RR = 0.30, 95% CI: 0.28–0.33) and non-Hodgkin's lymphoma (RR = 0.52, 95% CI: 0.48–0.56), in contrast to invasive cervical cancer (RR = 1.46, 95% CI: 1.09–1.94). Among the non-AIDS-defining cancers, the overall risk increased after the introduction of HAART (RR = 2.00, 95% CI: 1.79–2.23). The incidence of AIDS-defining cancers decreased and the incidence of non-AIDS-defining cancers increased after the early use of HAART, probably due to better control of viral replication, increased immunity and increased survival provided by new drugs.Journal of Infection and Public Health 10/2014; 8(1). DOI:10.1016/j.jiph.2014.08.003
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- "It has a clear association with immunosuppression and is one of the most frequent oral malignancies in human immunodeficiency virus (HIV) infected patients. In the pre- highly-active anti-retroviral therapy (HAART) era, the incidence of NHL was as high as 60-200 times greater in HIV-infected patients than in non-HIV-infected patients. However, since the introduction of HAART in the mid-1990s, the incidence of NHL appears to have been declining. "
ABSTRACT: Plasmablastic lymphoma (PL) is a type of non-Hodgkin's lymphoma (NHL) having a strong association with immunosuppression, especially, human immunodeficiency virus (HIV) infection. It generally has a poor prognosis with most patients dying within 2 years from initial presentation, and long-term survivors are very few. We report the case of a 10-years-old child, presenting in 2003 with swelling on the right side of the face and fever of 2 months. Evaluation revealed a mass in the right palatal and upper alveolar region with extensive spread and bone destruction, regional adenopathy, mass lesion in the liver and hepatosplenomegaly without bone marrow involvement. Histopathology was suggestive of the PL and patient tested positive for HIV. He was started on high grade NHL chemotherapy protocol along with highly-active anti-retroviral therapy HAART. He responded well and is in complete remission since 8 years of completion of treatment and is on HAART.Indian journal of medical and paediatric oncology 04/2013; 34(2):96-8. DOI:10.4103/0971-5851.116187
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- "The introduction and scaling up of free HIV antiretroviral therapy (ART) programme and insecticide-treated bednets (ITN) in 2003 did not seem to have an impact on the trends of Kaposi sarcoma, cervical cancer and Burkitt's lymphoma respectively as suggested by studies from other countries [13,14]. This could suggest that higher ART and ITN coverages are required to show impact on HIV and malaria related cancers than the current (2010) 65% coverage of estimated population in need of ART and 40% insecticide-treated bed net use in children under the age of five years [11,15]. "
ABSTRACT: Cancer is a leading cause of morbidity and mortality worldwide with a majority of cases and deaths occurring in developing countries. While cancer of the lung, breast, colorectum, stomach and prostate are the most common types of cancer globally, in east and southern Africa these are less common and comprehensive data to inform policies are lacking. Nationwide cancer registry was conducted between September and October 2010 in Malawi. New cancer cases registered from 2007 to 2010 were identified from hospital and clinic registers of 81 out of 84 health facilities providing cancer diagnosis, treatment or palliative care services. Demographic and cancer data were extracted from registers and case notes using a standard form. A total of 18,946 new cases of cancer were registered in Malawi from 2007-2010. Of these 55.9% were females, 7.2% were children aged less than 15 years, 76.5% were adults aged 15-59 years and 16.4% were elderly aged 60 years or more. Only 17.9% of the cases had histologically verified diagnosis, 33.2% were diagnosed clinically and 49.6% based on clinical and some investigations. Amongst females, cancer of the cervix was the commonest accounting for 45.4% of all cases followed by Kaposi sarcoma (21.1%), cancer of the oesophagus (8.2%), breast (4.6%) and non-Hodgkin lymphoma (4.1%). In males, Kaposi sarcoma was the most frequent (50.7%) then cancer of oesophagus (16.9%), non-Hodgkin lymphoma (7.8), prostate (4.0%) and urinary bladder (3.7%). Age-standardised incidence rate per 100,000 population for all types of cancer in males increased from 31 in 1999-2002 to 56 in 2007-2010. In females it increased from 29 to 69. Kaposi sarcoma and cancer of the oesophagus, cervical cancer and Kaposi sarcoma were the main causes for the increased incidence in males and females respectively. It was estimated that, annually at least 8,151 new cases of cancer (all types) occur in Malawi. This study provided data on common types and trends of cancer that could be used to focus prevention, treatment and control interventions in the context of limited resources. The problem of under-reporting and misdiagnosis of cancer cases has been highlighted.BMC Research Notes 03/2012; 5(1):149. DOI:10.1186/1756-0500-5-149