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HIV infection and malignancy: Management considerations

Authors
Liron Pantanowitz, MD
John F Deeken, MD
Section Editor
Bruce J Dezube, MD
Deputy Editor
Sadhna R Vora, MD

INTRODUCTION

HIV-infected individuals have an increased propensity to develop malignancy. The occurrence of an extremely high number of cases of Kaposi sarcoma (KS) was noted early in the AIDS epidemic and many of them had an unusually aggressive clinical course. KS was therefore included as an AIDS-defining illness in early case definitions from the Centers for Disease Control and Prevention (CDC). Non-Hodgkin lymphoma (NHL) and invasive cervical carcinoma were subsequently added as AIDS-defining conditions.

Subsequently, the spectrum of neoplasia in HIV-infected patients has changed as the use of potent antiretroviral therapy (ART) has become widespread (table 1). The incidence of KS and NHL has decreased markedly, but there has been a relative increase in malignancies that collectively are referred to as non-AIDS-defining cancers (NADCs) compared with the general population. NADCs now are a major factor contributing to mortality in HIV-infected people.

This topic will review general management considerations for patients with HIV and a malignancy, as well as a discussion of specific malignancies. The epidemiology and pathogenesis of malignancy in people infected with HIV are discussed separately. (See "HIV infection and malignancy: Epidemiology and pathogenesis", section on 'Introduction'.)

CLINICAL IMPLICATIONS

Malignancies in patients infected with HIV are often characterized by earlier age at onset, atypical pathology (higher tumor grade), more aggressive clinical behavior, and/or more advanced stage at presentation [1,2]. These features may have implications for screening and treatment, and may contribute to a poorer outcome, with rapid progression, a high rate of relapse, and a worse response to treatment.

Screening and prevention — The increased incidence of selected cancers in HIV-infected patients, combined with the younger age of onset and the altered biology, raise the question of whether more aggressive screening is indicated [2-4]. Most cancer screening guidelines do not make separate recommendations for individuals infected with HIV, with the exception of the European AIDS Clinical Society [5].

                               

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Literature review current through: Nov 2016. | This topic last updated: Tue Aug 30 00:00:00 GMT+00:00 2016.
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