Evolving epidemiology of malignancies in HIV

Abstract

Morbidity and mortality related to malignancy are increasing in HIV-infected patients. We aim at reviewing the literature on recent changes in the incidence of AIDS-defining and non-AIDS-defining malignancies and the specific characteristics of the main cancers emerging in HIV-infected patients. Currently, malignancies are the most frequent underlying cause of death (around one-third) of HIV-infected patients. Since the introduction of combination antiretroviral therapy, the incidence of Kaposi's sarcoma and cerebral lymphoma (among AIDS-defining cancers) decreased in parallel with AIDS-defining infections, whereas the incidence of systemic non-Hodgkin's lymphoma and cervical cancer decreased less than others and remains higher in HIV-infected patients than in the general population. The most recent and large studies have also shown a 1.7-3-fold higher risk of developing non-AIDS malignancies in HIV-infected patients as compared with the general population without a significant impact of combination antiretroviral therapy on these trends. These malignancies include Hodgkin's disease, lung, anal, head and neck cancers, hemopathies, and conjunctival cancers. In addition, the poorer prognosis reported in HIV-infected patients affected by malignancies might be interpreted as a consequence of late screening or immunosuppression. Prevention and screening management procedures need to be assessed on the basis of specific evidence-based studies in the HIV-infected population. Interventions, known to be efficacious in other populations, should systematically be used or adapted if necessary (alcohol and tobacco cessation programs and viral coinfection management). The respective role of HIV itself, immunosuppression, and antiretrovirals as pro-oncogenic factors need to be further examined.