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The growing problem of non-AIDS-defining malignancies in HIV

Pantanowitz, Lirona; Schlecht, Hans Pb; Dezube, Bruce Jc

doi: 10.1097/01.cco.0000239886.13537.ed
Cancer in AIDS

Purpose of review The incidence and spectrum of non-AIDS-defining cancers has continued to grow. As HIV-infected individuals live longer due to highly active antiretroviral therapy, their risk of dying from one of these cancers is increased. The recent literature pertaining to non-AIDS-defining cancers is reviewed.

Recent findings Recent epidemiological studies have identified higher rates of carcinoma of the anus, lung, breast, skin, conjunctiva, liver and prostate; hematopoietic malignancies such as Hodgkin's lymphoma, plasma-cell neoplasia and leukemia; and other neoplasms like melanoma and leiomyosarcoma in HIV-positive patients. The role of HIV-induced immunosuppression in the development of these non-AIDS-defining cancers appears less important than lifestyle habits like smoking and sun exposure, as well as coinfection with human papilloma, hepatitis B, hepatitis C and Epstein–Barr viruses.

Summary It is unclear whether the growing number of reports on non-AIDS-defining cancers reflects a true increased incidence or merely the product of increased surveillance, detection and reporting. Highly active antiretroviral therapy not only promotes longevity in the HIV-positive population, but may increase their risk of developing cancer like Hodgkin's lymphoma. Assertive prevention strategies are needed to adequately deal with non-AIDS-defining cancers in an aging and growing HIV-positive population.

aDepartment of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, USA

bDepartment of Medicine (Infectious Diseases), Beth Israel Deaconess Medical Center and the Clinical Investigator Training Program at Beth Israel Deaconess Medical Center/Harvard/MIT Health Sciences and Technology, Boston, USA

cDepartment of Medicine (Oncology), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Bruce J. Dezube, MD, Department of Medicine (Hematology-Oncology Division), CC-913, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA Tel: +1 617 667 7082; fax: +1 617 975 8030; e-mail:

Sponsorship: Harvard Medical School Center for AIDS Research P30 AI 060354 (to HPS), Clinical Investigator Training Program: Beth Israel Deaconess Medical Center – Harvard/MIT Health Sciences and Technology, in collaboration with Pfizer Inc. and Merck & Co (to HPS), Bristol-Myers Squibb Virology Fellowship (to HPS).

© 2006 Lippincott Williams & Wilkins, Inc.