Other non–AIDS-defining malignancies
As more effective control of HIV has become possible, patients are living longer and are being affected by types of cancers that are not directly induced by HIV. A growing number of reports from around the world now indicate that other malignant tumors, including Hodgkin lymphoma (HL), nonmelanomatous skin cancers, lung cancer, germ-cell tumors, myeloid or lymphoid leukemias, multiple myeloma, renal cell carcinoma, head and neck cancer, brain tumors, squamous tumor of the conjunctiva, and leiomyosarcoma in pediatric patients, are occurring in HIV-infected individuals.
Rates of other non–AIDS-defining cancers appear to be increasing among HIV-infected individuals. In an Australian cancer database, 196 cases of non–AIDS-defining cancers were noted in 13,067 individuals (1.5%) including 8,351 notified with HIV infection and 8,118 registered with AIDS. As HIV-infected individuals are surviving longer with currently available combination anti-HIV drugs, clinicians should anticipate seeing the development of more tumors in these patients. Greater vigilance for these tumors is warranted.
These non-AIDS defining cancers are generally treated with the same stage-adjusted strategies as would be used in individuals not infected with HIV.
Hodgkin lymphoma (HL)
Studies showing a possible increased incidence of HL in HIV-infected individuals have been reported from Europe, Australia, and the United States. The most common histology is mixed cellularity and lymphocyte-depleted. Male predominance, a higher prevalence of B symptoms, and more extranodal disease on presentation are the main characteristics of HL in HIV-infected patients.
Chemotherapy is recommended for this group of patients, due to the high proportion of stage III or IV disease. Standard treatments include doxorubicin(Drug information on doxorubicin), bleomycin, vinblastine, and dacarbazine(Drug information on dacarbazine) (ABVD) or ABVD alternating with vincristine mechlorethamine (Mustargen), vincristine, procarbazine(Drug information on procarbazine) (Matulane), and prednisone(Drug information on prednisone) (MOPP). More recently, early results with bleomycin(Drug information on bleomycin), etoposide(Drug information on etoposide), doxorubicin, cyclophosphamide(Drug information on cyclophosphamide), vincristine, procarbazine, and prednisone (BEACOPP) and the Stanford V regimen (mechlorethamine, doxorubicin, vinblastine(Drug information on vinblastine), vincristine, bleomycin, etoposide, and prednisone) look promising.
Nonmelanomatous skin cancers
As in the general population, basal cell carcinoma is more common than squamous cell carcinoma in the setting of HIV infection. The risk factors for the development of these tumors are the same as in the general population: namely, fair skin, history of sun exposure, and family history.
Lung cancer
Patients with HIV appear to have a higher relative risk of developing lung cancer than do age-matched controls (relative risk = 4.5; 95% confidence interval, 4.2 to 4.8). These tumors tend to present at later stages than do tumors with a similar histologic distribution in the general population.
Pediatric leiomyosarcoma
Cases of aggressive leiomyosarcoma developing in HIV-positive children have been reported. Leiomyosarcoma is a rare tumor, occurring in < 2 cases per 10 million non–HIV-infected children. However, a much higher than expected frequency of leiomyosarcoma has been reported in HIV-infected children. Visceral sites (eg, the lungs, spleen, and GI tract) are commonly involved.
