Evolving spectrum and incidence of non-AIDS-defining malignancies

Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA.
Current opinion in HIV and AIDS (Impact Factor: 4.68). 02/2009; 4(1):27-34. DOI: 10.1097/COH.0b013e32831a7259
Source: PubMed


Non-AIDS defining cancer (NADC) has emerged as an important cause of morbidity and mortality in the HIV-infected population. Insight into the incidence, spectrum, risk factors, management, and outcome of these cancers has continued to emerge. The recent literature on this topic is reviewed.
Several recent studies have explored the shifting spectrum of NADC in both developed and underdeveloped regions of the world. Investigators have shown only a minor difference in the geographic spectrum of NADC. Although several NADC have continued to occur at rates significantly higher than expected, a noticeable decline was observed in other cancers despite antiretroviral therapy. Factors other than HIV and immunosuppression proved to be important in the risk, treatment response, and outcome of these neoplasms. Studies dealing with the management of several NADC were published, including the role of highly active antiretroviral therapy (HAART).
An increased overall relative risk of developing NADC continues to be reported in the HIV-infected population worldwide. The development of NADC appears to be multifactorial. Although control of HIV viremia has proven to be beneficial, the impact of HAART on NADC incidence rates and survival is not uniform. Further effort is needed to resolve the direct and indirect effects of HIV on NADC in order to guide effective prevention and treatment strategies of these malignancies.

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Available from: Liron Pantanowitz, Apr 28, 2014
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    • "Epidemiological studies have demonstrated a combination of HIV-specific risk factors such as a CD4 T-cell count of ≤200 ␮L, duration of HIV infection and interruptions in HAART. In addition, traditional risk factors predisposing to malignancy, including risky sexual behaviors , smoking, sun exposure, infection with other oncogenic viruses as well as a familial history of cancer, likely play significant roles [8] [10] "
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    • "With HAART therapy, the major cause of death in the later stage of acquired immune deficiency syndrome (AIDS) is malignancy, rather than infection. Moreover, the spectrum of malignancies encountered in HIV-positive patients has expanded to include both AIDS-defining cancers, such as cervical cancer, Kaposi sarcoma (KS), and non-Hodgkin's lymphoma (NHL), as well as non-AIDS-defining cancers (NADC), such as Hodgkin's lymphoma, anal cancer, lung carcinoma, and nonmelanotic skin cancer [1]. However, individuals unlikely to be on HAART therapy are still presented with opportunistic infections, such as tuberculosis, fungi, and parasites. "
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