JAIDS Journal of Acquired Immune Deficiency Syndromes:
Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, MD
HIV has been linked to malignancy since the first reports of Kaposi Sarcoma were a harbinger of the pandemic to come. Two herpes viruses, EBV (certain lymphomas) and HHV-8 (KSHV) (Kaposi Sarcoma) and pathogenic strains of HPV (cervical cancer) have been linked to the majority of AIDS-defining malignancies. These viruses are also linked to a number of cancers elevated in patients with HIV including some lymphomas (EBV and HHV8), Primary Effusion lymphoma (HHV-8), hepatocellular cancers (HBV, HCV) and penile and anal cancers (HPV). Through AIDS cancer matching studies and HIV cohort and clinical analyses a broader spectrum of HIV-associated malignancies have been reported and in European and US cohorts cancer is the leading cause of death in the HAART era as patients survive longer. Some such as Hodgkins disease are EBV associate while other such as lung cancer have yet to have an etiologic association with viruses. In sub-Saharan Africa, information on HIV-associated malignancies is sparse and with the exception of an AIDS Cancer Match study from Uganda are descriptive. With the scale up of antiretroviral therapy, the PEPFAR program provides an important platform for expansion of cancer research since it represents the largest cohort of HIV infected patients ever assembled. There are significant opportunities to define the spectrum of HIV-associated malignancies through improved integration of HIV and oncology services. Additionally, studies of these malignancies may provide new insights concerning viral etiology of cancer in HIV-infected cohorts. For example in West Africa, new strains of HTLV, HTLV-3 and HTLV-4 have been described that have yet to be linked to human disease, and emerging data link HPV to certain forms of head and neck cancer. Linking epidemiological cohorts to cancer virology basic study provides a path for expanding insights about the role of viruses in malignancy.