WASHINGTON—AIDS deaths in the United States total more than 440,000 since 1981, according to a new Department of Health and Human Services (HHS) fact sheet. The number of HIV-infected Americans now stands at an estimated 850,000 to 950,000, one quarter of whom do not know they carry the virus.
The article by Drs. Gates and Kaplan provides an excellent review of malignancies associated with human immunodeficiency virus (HIV)-1 disease and chronicles the epidemiologic changes seen during the past 5 years. The literature review is very thorough and well balanced.
A dramatic spike in the incidence of Kaposi’s sarcoma (KS) in never-married men in New York and California in 1981 was one of the first indications of a new disease now known as acquired immunodeficiency syndrome (AIDS). We now appreciate a number of mechanisms by which human immunodeficiency virus (HIV) infection contributes to the pathogenesis of these tumors. The article by Drs. Gates and Kaplan provides an excellent review of changes in the epidemiology, presentation, and treatment of these tumors since the development of potent combination anti-HIV therapy.
The introduction of highly active antiretroviral therapy (HAART) has had a dramatic impact on the morbidity and mortality of individuals living with human immunodeficiency virus (HIV). In addition to contributing to declines in the incidence of several opportunistic infections, HAART is affecting the incidences of several acquired immunodeficiency syndrome (AIDS)-defining malignancies.
HOUSTON—Physicians at Ben Taub General Hospital, Houston, noticed that an unusual number of patients were presenting with lymphoma as their first AIDS-defining event. This observation prompted a retrospective study of all HIV-positive patients with non-Hodgkin’s lymphoma presenting between 1989 and 2000.
Dr. Armitage presents a succinct and thorough review of the role of mitoxantrone (Novantrone) in patients with non-Hodgkin’s lymphoma (NHL). He begins by emphasizing the importance of accurate diagnosis as described in the World Health Organization classification which evolved from the Revised European American Lymphoma classification. Both of these present day classifications are based on the immunologic principles separating lymphomas into B- and T-cell disorders developed in the 1970s by Lennert, Lukes, and Collins.[1,2] His review addresses multiple issues in mitoxantrone therapy, including dose intensity, cardiotoxicity, combination therapy with nucleoside analogs in low-grade lymphomas, the impact of rituximab (Rituxan), therapy for acquired immunodeficiency syndrome (AIDS)-related lymphoma, and the role of high-dose mitoxantrone as part of a preparative regimen for autologous transplants.
The association between HIV infection and the development of cancer was noted early in the acquired immunodeficiency syndrome (AIDS) epidemic. The AIDS-defining malignancies are Kaposi’s sarcoma, intermediate- or high-grade B-cell non-Hodgkin’s lymphoma (NHL), and cervical cancer. All of these cancers feature specific infectious agents in their etiology. These agents are human herpesvirus 8/Kaposi’s sarcoma-associated herpesvirus, or HHV-8/KSHV (implicated in Kaposi’s sarcoma), Epstein-Barr virus, or EBV (in primary central nervous system lymphoma and a subset of systemic B-cell NHL) and human papillomavirus, or HPV (in cervical cancer).
ORLANDO—A large percentage of HIV-infected patients present with non-Hodgkin’s lymphoma (NHL) as their initial AIDS-defining illness, according to a retrospective study in patients with HIV-related systemic NHL at one institution. Garrett R. Lynch, MD, reviewed the data at the American Society of Hematology (ASH) annual meeting (abstract 1434).
New research from the AIDS Institute at the University of California, Los Angeles (UCLA), reveals that stress enables the human immunodeficiency virus (HIV) to spread more quickly in infected persons and prevents antiretroviral drugs from restoring immune system function. The study, which was reported in the Proceedings of the National Academy of Sciences (98:12695-12700, 2001), is the first to pinpoint the molecular mechanisms linking stress and HIV infection. "Popular science has widely suspected that stress weakens the immune system," said Steve Cole, MD, lead author and UCLA assistant professor of hematology-oncology. "Now we’ve uncovered two reasons why."
ROCKVILLE, Maryland—Researchers at the Food and Drug Administration and the Veteran’s Administrations will join in an effort to determine whether HIV infection or certain drugs used to treat it cause avascular necrosis (AVN). The disorder,