C-105 Lymphomas and other cancers in HIV-infected patients

Abstract

Non Hodgkin lymphoma (NHL) is the most frequent cancer in patients with HIV/AIDS (PWHA) in the post-cART era. Interestingly, an increase in Hodgkin lymphoma (HL) risk with declining CD4 counts has been shown, although much less steep than NHL. The most common NHL types in PWHA are diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL). Some rare types of lymphomas occur nearly exclusively in PWHA patients, i.e. primary effusion lymphoma (PEL) and its solid variants, lymphoma associated with Kaposi sarcoma-associated herpesvirus (KSHV)-related multicentric Castleman disease (MCD), and plasmablastic lymphoma of the oral cavity type. Lymphomas occurring in PWHA are closely linked to other viral infection. BL, DLBCL, plasmablastic lymphoma and HL are associated with Epstein-Barr virus (EBV) infection, though not uniformly. PEL and its solid variants are consistently linked to KSHV. EBV is also expressed in 70–80% of PEL cases. Significant increases were also found for cancers of the lung, liver, anal, oropharynx, cervix and non-melanocytic skin tumors. These cancers are mostly infection-related, and exhibit pathologic features similar to those observed in HIV-negative patients. Coinfection with different viruses represents a common issue in malignancies in PWHA. MCD has become increasingly relevant in recent years given its association with HIV and KSHV infections. Although MCD, KS, PEL and HL are disease entities displaying distinct clinical and pathological features, KSHV associated MCD is usually a tangle of these different entities. A comprehensive understanding of the intricacies of the HIV, KSHV and EBV coinfection will probably lead to additional advances in therapy and managements of the affected patients.