European Journal of Cancer: Highlights of Issue 37:10

Epidemiology, pathogenesis and clinicopathological aspects of HIV-related cancers

Decreased incidence of HIV-related KS following HAART therapy

New targeted and individualised therapies for the treatment of HIV-related cancers

The changing face of HIV-related cancers

Since the advent of the Acquired Immunodeficiency Syndrome (AIDS) epidemic, Human Immunodeficiency Virus (HIV)-infected patients have presented with a plethora of AIDS-related cancers, some of which, such as Kaposi's Sarcoma (KS), intermediate or high-grade B-cell Non-Hodgkin's Lymphomas (NHL) and invasive cervical carcinomas (ICC), are now classified as AIDS -defining conditions according to the Centers for Disease Control (CDC). These cancers often differ from the diseases seen in the non-HIV infected populations in both their pathogenesis and clinical presentation.

With the introduction of Highly Active AntiRetroviral Therapy (HAART) therapy, the clinical management of AIDS-related cancers has changed dramatically. This therapy has resulted in a reduction in the incidence rates for KS and cerebral lymphomas, but the data for lymphomas in general are inconsistent. Furthermore, there are no clear changes in the incidence rates for ICC. These differential effects of HAART may be related to different CD4 counts that tend to be higher in systemic NHL patients, such as those with Burkitt's lymphoma (BL), compared with the counts associated with KS and primary brain lymphomas. Thus, the partial immune reconstitution observed following HAART may not be sufficient to prevent the development of BL. Interestingly, the different categories of lymphomas are derived from distinct B-cell subsets and are associated with different pathogenetic pathways and the host background is involved in which lymphomas develop. This may partly explain the differing trends in incidence for patients developing lymphomas. The decrease in opportunistic infections and the increased life expectancy following HAART are also likely to have influenced incidence rates in recent years. In addition, cancers associated with a lower level of immunosuppression may become more prevalent in the future as a result of the increased life expectancy of patients treated with HAART.

Therapies are being designed against specific targets as more is known about these diseases, with anti-viral therapies aimed at co-infecting viruses such as Human Herpes Virus 8 (HHV8) or Epstein-Barr Virus (EBV). Rituximab, which rapidly destroys circulating B cells, is effective in treating some post-transplant lymphomas and could be applied to HIV-infected patients if it were possible to identify a suitably high-risk group of patients. Moreover, therapy should be decided, where possible, according to an individual's prognostic characteristics (such as their CD4 count) and supportive care is often provided. New packaging techniques such as liposomal preparations are also now being utilised that result in an increased half-life of the drug and are often associated with a reduced toxicity.

Thus, with these new therapies, the landscape of HIV-related disease is constantly changing. We feel confident, however, that we are getting closer to important, decisive results in the treatment of cancers in the HIV-setting.

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