AIDS-Related Malignancies: Emerging Challenges in the Era of Highly Active Antiretroviral Therapy

Abstract

Abstract Learning Objectives After completing this course, the reader will be able to: Describe the pathogenesis and clinical presentation of Kaposi's sarcoma, with a special emphasis on Kaposi's sarcoma herpesvirus/human herpesvirus-8, and outline treatment approaches.Discuss the pathogenesis, epidemiology, and treatment of AIDS-related lymphomas.Discuss the increasing incidence of non-AIDS-defining malignancies such as Hodgkin's lymphoma and plasma cell disorders in patients with HIV infection.Explain how, in the era of highly active antiretroviral therapy, both AIDS-related lymphoma and Hodgkin's lymphoma patients may be treated with therapies previously reserved for their immunocompetent counterparts. Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com Human immunodeficiency virus (HIV)-infected patients are at increased risk of developing cancer, particularly in the later stages of acquired immune deficiency syndrome (AIDS). Despite the advent of highly active anti-retroviral therapy (HAART), malignancy in this population is a leading cause of morbidity and mortality. Kaposi's sarcoma (KS) and AIDS-related non-Hodgkin's lymphoma (ARL) are the most common AIDS-defining malignancies. AIDS-related KS varies from minimal to fulminant disease. Treatment decisions for AIDS-related KS are guided largely by the presence and extent of symptomatic disease. In addition to HAART, excellent treatments exist for both localized disease (topical gel, radiotherapy, and intralesional therapy) and advanced disease (liposomal anthracyclines, paclitaxel). Novel therapies that have become available to treat AIDS-related KS include angiogenesis inhibitors and antiviral agents. ARL comprises a heterogeneous group of malignancies. With the immune restoration afforded by HAART, standard-dose chemotherapies now can be safely administered to treat ARL with curative intent. The role of analogous treatments used in HIV-negative patients, including monoclonal antibodies and autologous stem cell transplantation, requires further clarification in HIV-positive patients. HIV-infected patients also appear to be at increased risk for developing certain non-AIDS-defining cancers, such as Hodgkin's lymphoma and multiple myeloma. Although the optimal treatment of these neoplasms is at present uncertain, recent advances in chemotherapy, antiretroviral drugs, and supportive care protocols are allowing for more aggressive management of many of the AIDS-related cancers. This article provides an up-to-date review of the epidemiology, pathogenesis, clinical features, and treatment of various AIDS-related malignancies that are likely to be encountered by an oncologist practicing in the current HAART era.