Human immunodeficiency virus (HIV) related malignancies

20 Human immunodeficiency virus (HIV) related malignancies



TV. Ajithkumar



Introduction


Malignancies have a significant impact on the morbidity and mortality of people with human immunodeficiency virus (HIV) infection. 30–40% of HIV-infected patients develop malignancies during the course of their illness. Some of the malignancies are AIDS-defining conditions whereas others appear to be more common in HIV patients (Box 20.1). Although AIDS-defining malignancies may be caused mainly by progressive immunosuppression, the exact relationship between immunosuppression and non-AIDS-defining malignancies is yet to be established. The most common cancers in the general population such as breast, prostate and colon do not appear to increase in HIV infection.



Box 20.1
Cancers in HIV patients



AIDS-defining cancers



• Kaposi’s sarcoma

• Invasive cervical cancer

• Non-Hodgkin’s lymphoma
• Burkitt’s

• Immunoblastic

• Primary cerebral


Non-AIDS-defining cancers



• Anal cancer

• Liver cancer

• Hodgkin’s disease

• Penile cancer

• Vulva and vagina cancer

• Oral cavity and pharynx

• Larynx

• Lung

• Myeloma

• Acute myeloid and monocytic leukaemia

Introduction of highly active antiretroviral therapy (HAART) has brought significant changes to the natural history of HIV-infection. The incidence of Kaposi’s sarcoma and NHL has generally declined whilst the incidence of Hodgkin’s lymphoma and non-AIDS-defining cancers has not changed. With the introduction of antiretroviral therapy, 28% of deaths in HIV infection are due to cancer compared with 10% before HAART.



Pathogenesis


Development of cancers in HIV-infected individuals may be similar to that occurring in patients with immunosuppression and immune-deficiency disorders. The possible mechanisms for increased incidence of various malignancies in HIV-infected people include:


• Immunosuppression – organ transplant recipients have an almost 100-fold increased risk compared with the general population.

• Though HIV is not generally considered as oncogenic, a possible direct role has been suggested recently.

• Increased risk of other viral infections – such as Epstein–Barr virus (Hodgkin’s disease), human papilloma virus (cervical cancer, anal cancer), human herpes virus (Kaposi’s sarcoma) and hepatitis virus (hepatocellular carcinoma).


AIDS-defining malignancies



Kaposi’s sarcoma


KS is one of the most common neoplasms in HIV-infected patients, associated with human herpes virus-8 (HHV-8). With the introduction of highly active anti-retroviral therapy (HAART), the risk of both visceral and cutaneous KS has decreased dramatically.


The clinical manifestation of KS varies from a mild to a fulminant course. Skin lesions appear mainly on the lower extremities, face and genitalia. Skin lesions are typically multifocal and papular (Figure 20.1

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Jun 18, 2016 | Posted by in ONCOLOGY | Comments Off on Human immunodeficiency virus (HIV) related malignancies

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