Malignancies have been detected in approximately 40% of all patients with acquired immunodeficiency syndrome (AIDS) sometime during the course of their illness.
Jay S. Cooper, MD
Malignancies have been detected in approximately 40% of all patients with acquired immunodeficiency syndrome (AIDS) sometime during the course of their illness. These cancers have been both a primary cause of death in some patients and also a source of considerable morbidity. In the current era of highly active antiretroviral therapy (HAART), patients infected with the human immunodeficiency virus (HIV) are surviving longer than ever. HAART appears to have substantially reduced the incidence of Kaposi’s sarcoma (KS) and non-Hodgkin lymphoma (NHL) and may enhance the efficacy of treatment for those patients who do develop these tumors. Unfortunately, HAART has not shown a similar effect on the development of other types of neoplasms, and caring for patients who develop malignancies in the setting of HIV remains a challenge. Furthermore, HAART is not available universally, with many patients in resource-poor developing countries not having access to antiretroviral drugs.
In the past, locoregionally advanced head and neck cancer routinely was treated by surgery followed by adjuvant radiation therapy, unless the disease was too extensive to be resected and treatment defaulted to radiation therapy alone.
In this edition of Clinical Quandaries, Trombetta et al present a 64-year-old man who seeks care because of a new, asymptomatic right midneck mass. Because the mass is not warm or tender and the patient does not have an elevated temperature, an infectious etiology is unlikely. We are not told if he is a smoker or drinker and we assume he does not have any other signs or symptoms (such as recent-onset hoarseness) that would point us to a head and neck cancer as a primary source.
Commentary (Cooper): Nutritional Support of Patients Undergoing Radiation Therapy for Head and Neck Cancer
What do we know for sure
about the health implications
weight and nutrition? We know that
approximately 60% of US adults currently
are considered overweight or
obese and approximately 300,000
deaths a year in this country are associated
with overweight and obesity.
And, most importantly for this discussion,
we know that randomized
controlled trials suggest that lifestyle
changes resulting in the loss of excess
weight reduce the risk cardiovascular
disease, lower blood pressure, lower
blood sugar, and improve lipid levels.[
2] In essence, there is a chain of
evidence: A medical condition exists,
the condition causes adverse outcomes,
with interventions the condition
can be reversed, and the problems
it causes can be ameliorated.
The first 15 years of the AIDS pandemic can be summarized simply by the oxymoron "constant change." The syndrome unfailingly has presented new challenges and demanded nearly continual refinement of our patterns of management. In the future, progressively more effective antiretroviral therapy paradoxically may permit infected patients to live longer and fall victim to more HIV-related and HIV-independent malignancies. Swift's review of the role of radiation therapy in the setting of HIV infection therefore provides a useful "snapshot" of current standards and a necessary warning of likely changes to come. Several points warrant emphasis.