Autologous hematopoietic cell transplantation is a safe and effective treatment option for patients with HIV-associated lymphoma, according to a study presented at ASH 2014.
With National HIV Testing Day recently behind us and the 19th International AIDS conference happening later in July in Washington, DC, I would like to share some recent HIV/AIDS statistical, research, and policy highlights.
We’re now entering the fourth decade of HIV/AIDS awareness. Last year marked the 30th anniversary of the earliest report (on June 5, 1981) of what is now known as AIDS (acquired immune deficiency syndrome).
Thanks to the widespread use of highly active antiretroviral therapy (HAART), AIDS patients continue to live longer after their initial diagnosis.
Though there are no data yet on their efficacy, oleander extracts are promoted to treat cancer, AIDS, and congestive heart failure, and are being investigated in clinical trials.
HIV’s disruption of immune system function may cause the immune system cells themselves to become cancerous, NCI researchers have concluded. If so, this might explain why patients with AIDS are 100 times more likely to be diagnosed with non-Hodgkin’s lymphoma than the general population.
The treatment of anal squamous cell cancer with definitive chemoradiation is the gold-standard therapy for localized anal cancer, primarily because of its sphincter-saving and colostomy-sparing potential.
Although anal cancer is a rare disease, its incidence is increasing in men and women worldwide. The most important risk factors are behaviors that predispose individuals to human papillomavirus (HPV) infection or immunosuppression. Anal cancer is generally preceded by high-grade anal intraepithelial neoplasia (HGAIN), which is most prevalent in human immunodeficiency virus (HIV)-positive men who have sex with men. There is a general consensus that high-risk individuals may benefit from screening. Meta-analysis suggests that 80% of anal cancers could be avoided by vaccination against HPV 16/18. Nearly half of all patients with anal cancer present with rectal bleeding. Pain or sensation of a rectal mass is experienced in 30% of patients, whereas 20% have no tumor-specific symptoms. According to the Surveillance Epidemiology and End Results (SEER) database, 50% of patients with anal cancer have disease localized to the anus, 29% have regional lymph node involvement or direct spread beyond the primary, and 12% have metastatic disease, while 9% have an unknown stage. Clinical staging of anal carcinoma requires a digital rectal exam and a computed tomography scan of the chest, abdomen, and pelvis. Suspicious inguinal lymph nodes should be subject to pathologic confirmation by fine-needle aspiration. The 5-year relative survival rates are 80.1% for localized anal cancer, 60.7% for regional disease, and 29.4% for metastatic disease. Part 2 of this two-part review will address the treatment of anal cancer, highlighting studies of chemoradiation.
Reishi mushroom is widely used in Asia and around the world as an immunostimulant. With extracts derived from both the cap and the stem of the mushroom, its biologic activity is thought be due to beta-glucan polysaccharides and compounds called triterpenes.
Squamous cell anal cancer remains an uncommon entity; however,
the incidence appears to be increasing in at-risk populations, especially
those infected with human papillomavirus (HPV) and human immunodeficiency
virus (HIV). Given the ability to cure this cancer using synchronous
chemoradiotherapy, management practices of this disease are
critical. This article considers treatment strategies for HIV-positive patients
with anal cancer, including the impact on chemoradiation-induced
toxicities and the role of highly active antiretroviral therapy in the treatment
of this patient population. The standard treatment has been
fluorouracil (5-FU) and mitomycin (or cisplatin) as chemotherapy agents
plus radiation. Consideration to modifying the standard treatment regime
is based on the fact that patients with HIV tend to experience greater
toxicity, especially when CD4 counts are below 200; these patients also
require longer treatment breaks. Additional changes to the chemotherapy
dosing, such as giving 5-FU continuously and decreasing mitomycin dose,
are evaluated and considered in relation to radiation field sizes in an effort
to reduce toxicity, maintain local tumor control, and limit need for
colostomy. The opportunity for decreasing the radiation field size and
using intensity-modulated radiation therapy (IMRT) is also considered,
particularly in light of the fact that IMRT provides dose-sparing while
maximizing target volume dose to involved areas. The impact of the immune
system in patients with HIV and squamous cell carcinoma of the
anus and the associated response to therapy remains unknown. Continued
studies and phase III trials will be needed to test new treatment strategies
in HIV-infected patients with squamous cell cancer of the anus to
determine which treatment protocols provide the greatest benefits.