HIV-related Malignancies Research Articles

Review article: the aetiology, investigation and management of diarrhoea in the HIV-positive patient

Diarrhoea is a common presentation throughout the course of HIV disease. To review the literature relating to aetiology, investigation and management of diarrhoea in the HIV-infected adult. The PubMed database was searched using major subject headings 'AIDS' or 'HIV' and 'diarrhoea' or 'intestinal parasite'. The search was limited to adults and to studies with >10 patients. Diarrhoea affects 40-80% of HIV-infected adults untreated with antiretroviral therapy (ART). First-line investigation is by stool microbiology. Reported yield varies with geography and methodology. Molecular and immunological methods and special stains have improved diagnostic yield. Endoscopy is diagnostic in 30-70% of cases of pathogen-negative diarrhoea and evidence supports flexible sigmoidoscopy as a first line screening procedure (80-95% sensitive for CMV colitis), followed by colonoscopy and terminal ileoscopy. Radiology is useful to assess severity, distribution, complications and to diagnose HIV-related malignancies. Side effects and compliance with ART are important considerations in assessment. There is a good evidence base for many specific therapies, but optimal treatment of cryptosporidiosis is unclear and only limited data support symptomatic treatments. The immunological response to HIV infection and Antiretroviral therapy remains incompletely understood. Antiretroviral therapy regimens need to be optimised to suppress HIV while minimising side effects. Effective agents for management of cryptosporidiosis are lacking. There is an urgent need for enhanced regional diagnostic facilities in countries with a high prevalence of HIV. The ongoing roll-out of Antiretroviral therapy in low-resource settings will continue to change the aetiology and management of this problem, necessitating ongoing surveillance and study.

FIV associated neoplasms—A mini-review

Retroviral induced neoplasms have been key to understanding oncogenesis and are important etiologic agents associated with cancer formation. Cats infected with feline immunodeficiency virus (FIV), the feline analogue to human immunodeficiency virus (HIV), are reported to be at increased incidence of neoplasia. This review highlights reported risk factors and tumor cell phenotypes associated with neoplasias arising in FIV-infected animals, differences in oncogenic disease in natural versus experimental FIV infections, and similarities between FIV- and HIV-related malignancies. The most common type of FIV-associated neoplasm reported in the literature is lymphoma, specifically of B-cell origin, with experimentally infected cats developing neoplastic lesions at an earlier age than their naturally infected cohorts. The mechanism of FIV-induced lymphoma has not been completely ascertained, though the majority of published studies addressing this issue suggest oncogenesis arises via indirect mechanisms. HIV-infected individuals have increased risk of neoplasia, specifically B cell lymphoma, in comparison with uninfected individuals. Additional similarities between FIV- and HIV-associated neoplasms include the presence of extranodal lymphoma, a synergism with other oncogenic viruses, and an apparent indirect mechanism of induced oncogenesis. This literature supports study of FIV-associated neoplasms to further characterize this lentiviral-neoplasia association for the benefit of both human and animal disease, and to advance our general knowledge of mechanisms for viral-induced oncogenesis.

Peripheral Blood Stem-Cell Mobilisation and Autologous Stem Cell Transplantation In HIV-Related Malignancies.

AbstractAbstract 4592 Introduction:Patients (pts) with HIV-infection are generally excluded from clinical trials that evaluate the role of high dose chemotherapy (HDCT) in malignant lymphoma or relapsed germ cell tumor (GCT). However, recent data indicate that HDCT followed by autologous peripheral blood stem cell transplantation (ASCT) may be effective in relapsed HIV-related lymphoma. Methods:This is an observational cohort study including patients with HIV-related lymphoma or HIV-related GCT who have peripheral blood stem cells mobilized by a combination of chemotherapy (CT) and G-CSF. Pts did or did not undergo consecutive ASCT. The primary outcome measure is feasibility. High-dose BEAM was used as a conditioning regimen in pts with HIV-related lymphoma while high-dose carboplatin/etoposide (CE) was chosen for pts with GCT. Results:From 07/05 to 03/10 peripheral blood stem cells (PBSC) were successfully harvested in 10 of 11 HIV-infected pts with diffuse large B-cell lymphoma (DLBCL) [n=4], Burkitt's lymphoma (BL) [n=3], plasmablastic lymphoma (PL) [n=2], Hodgkin lymphoma (HL) [n=1] and testicular GCT [n=1]. The mean number of collected stem cells was 15.7×106/kg CD34+ cells (range, 6.3 – 33). PBSC-mobilisation failed in one pt with relapsed BL. 7 of 11 pts were mobilized following salvage CT for DLBCL [n=4], BL [n=1], HL [n=1] or GCT [n=1] while 4 pts were under primary CT for BL or PL. So far, 5 of 10 pts received HDCT + ASCT. Pt 1 (44 yrs, CDC C3; HIV-RNA< 50 cop/ml at time of SCT) received HDCT as 3rd salvage therapy for DLBCL. A total of 9.2 × 106/kg CD34+ cells were transplanted. Neutrophil engraftment occurred on day +14. The pt achieved a partial remission but died of progressive lymphoma 6 months after ASCT. Pt 2 (60 yrs, CDC B3; HIV-RNA< 50/ml) underwent HDCT + ASCT (13.8 × 106/kg CD34+ cells) for a 1st relapse of HL. Neutrophil engraftment was observed on day +10. The pt is well and disease free 25 months after ASCT. Pt 3 (26 yrs, CDC C3, HIV-RNA< 50/ml), a hepatitis C co-infected haemophiliac, received HDCT + ASCT for refractory DLBCL but died of liver cirrhosis and neutropenic sepsis with multi-organ failure on day +16. Pt 4 (25 yrs, CDC A3, HIV-RNA< 50/ml) received 3 sequential courses of HD-CE followed by ASCT in 3-week intervals for a 3rd relapse of a nonseminomatous GCT. Neutrophil engraftment occurred on day +10, + 12 and +14, respectively. A complete remission (CR) was achieved. However, the pt suffered another relapse involving the central nervous system and died of progressive GCT 15 month after the 3rd transplant. Pt 5 (41 yrs, CDC C3, HIV-RNA 220/ml) underwent HDCT in 2nd complete remission after successful salvage-CT for a first sensitive relapse of DLBCL. A total of 12.9 × 106/kg CD34+ cells were transplanted. The pt is currently alive and neutropenic (day +3). ASCT was not performed in the other 6 pts because of refractory BL [n=1], ongoing first remission following induction CT for BL [n=2] and PL [n=2] and concomitant histoplasmosis necessitating antifungal therapy [n=1]. Conclusions:Successful mobilisation of PBSC is feasible in the majority of pts with HIV-related malignancies. ASCT seems effective in selected pts with chemo-sensitive relapse of malignant lymphoma or GCT. HIV-infected pts should no longer be excluded from HDCT-programs. Disclosures:No relevant conflicts of interest to declare.

Prevalence of HIV among general surgical patients in southeastern Nigeria

Background With the advent of HAART, many HIV patients are now living longer. It is expected that the incidence of HIV-related malignancies will increase, with additional burden of operating on HIV patients in areas of chronic severe shortages where minimum basic precautions may not always be feasible. We decided to assess the HIV prevalence in surgical patients and compare the periods 2001-04 and 2008-09.

The Impact of HAART on HPV-Related Cervical Disease

highly active antiretroviral therapy (HAART) has had an unequivocally positive impact on morbidity and mortality in HIV-infected individuals. These benefits have clearly extended to some HIV-related malignancies, including Kaposi's sarcoma and non-Hodgkin's lymphoma. The impact of HAART on cervical cancer, however, remains uncertain. The objective of this review is to summarize the last ten years of registry-based and clinical research into the impact of HAART on human papillomavirus (HPV) related cervical disease. compared to their HIV-uninfected counterparts, HIV-infected women have an increased prevalence of HPV infection, increased risk of progression of HPV-related cervical disease, and an increased risk of invasive cervical cancer. While the partial immune reconstitution afforded by HAART might be expected to decrease susceptibility to HPV infection and cervical disease, the local effects of improved immunosurveillance on the cervix are uncertain and the increased longevity of patients on HAART may increase risk of exposure to HPV and provide the time required for progression of cervical disease. Registry-based evidence has been consistent in identifying the lack of decrease in cervical cancer incidence in the HAART era. Clinical research on the subject, however, has produced conflicting evidence with regards to both the effect of HAART on HPV infection and its impact on cervical disease progression/regression. the incidence of cervical cancer has not decreased in the HAART-era. Furthermore, clinical research has not shown a clear benefit of HAART in decreasing HPV-related cervical disease in HIV-infected women. A better understanding of this subject will have an impact on cervical disease surveillance practices.

Diagnosis of HIV-related malignancies in resource-constrained settings of sub-Saharan Africa, a cautionary tale for non-Hodgkin’s lymphoma

Background Non-Hodgkin’s lymphoma (NHL) subgroups, immunophenotypes, and genotypes have been defined in developed countries but how that information translates to resource-constrained sub-Saharan Africa medical settings is undocumented. Local published data on NHL subgroups come largely from retrospective clinical biopsy study sets of paraffin-embedded tissues filed in local pathology archives. Relatively poorer representation of the rural and low socioeconomic populations is likely in such data. Prospectively identified NHL subgroups using immunologic and molecular techniques in consecutive presentations of patients would best clarify NHL subgroups and confounding diagnoses.

Abstract B8: Research on HIV/AIDS-related cancers among racial/ethnic minority and underserved persons in the United States

Abstract Purpose: To develop a community based participatory research (CBPR) program that establishes an effective way to engage Africans in Zambia and underserved Alabama Black Belt communities in HIV awareness, stigma reduction, voluntary HIV testing and engagement in care, active and appropriate prevention and early detection of HIV-related malignancies, and proper treatment, when necessary. Background: The Deep South Network for Cancer Control has trained over 800 community health advisors (CHAs) that have functioned to increase cancer awareness in their communities, leading to considerable improvement in breast and cervical cancer screening in the targeted communities. The UAB Center for Infectious Disease Research in Zambia (CIDRZ) has reached over 500,000 women for preventing mother-to-child transmission and has enrolled over 200,000 HIV patients into care. They screen over 1,000 women per month for cervical cancer. A major common issue in both programs is the stigma associated with HIV. This leads to unwillingness to be screened, continuous transmission of disease, and subsequent development of HIV-related malignancies. Methodology: Bring the two communities together to learn from each other in order to develop an appropriate community based participatory research strategy to overcome the major issues. This would be accomplished by: (1) establishing an organizational infrastructure to form a foundational research program (2) conducting onsite meetings in the United States and Zambia to experience the unique attributes of each country (3) conducting a needs assessment to evaluate infrastructure addressing HIV testing and HIV-related cancer prevention, early detection and/or treatment at three levels: community, investigators and institution (4) developing a CBPR plan to insure underserved minorities in the Alabama Black Belt and Zambia receive appropriate HIV testing and HIV-related cancer prevention, early detection, and/or treatment. Results: There were many lessons learned in Lusaka and in Alabama: 1) Peer educators play a vital role in outreach and support. Peer educators who are a part of the program, must be involved in support groups as well. 2) Peer educators have more impact when they are trained individuals. 3) Community ownership is important; have to find the passion in the community and have the ownership working from the inside out. 4) Education offered in the work place yields positive results. 5) Mass media dissemination has a great influence on the message being carried. 6) Targeted campaigns have proven beneficial. 7) Health fairs are widely received. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B8.

HIV-K: an integrative knowledge base for semantic integration of AIDS-related malignancy data and treatment outcomes.

Technological innovations such as web services and collaborative Grid platforms like caGrid can create opportunities to converge the worlds of health care and clinical research, by facilitating access and integration of HIV-related malignancy clinical and outcomes data at more sophisticated, semantic levels. At the same time, large numbers of randomized clinical trial and outcomes data on AIDS-defining malignancies (ADM) and non-AIDS-defining malignancies (nADM) have been produced during the last few years. There is still much work to do, though, on obtaining clear conclusions from the integration of such information. This is a white paper on work in progress from Emory University's HIV/AIDS related malignancy data integrative knowledge base project (HIV-K). We are working to increase the understanding of available clinical trial data and outcomes of ADM such as lymphoma, as well as nADM such as anal cancer, Hodgkin lymphoma, or liver cancer. Our hypothesis is that, by creating prototypes of tools for semantics-enabled integrative knowledge bases for HIV/AIDS-related malignancy data, we will facilitate the identification of patterns and potential new overall evidence, as well as the linking of integrated data and results to registries of interest.

Risk factors for mortality in AIDS-associated Kaposi sarcoma in a primary care antiretroviral treatment program in Malawi

AIDS-associated Kaposi sarcoma (AIDS-KS) is the most common HIV-related malignancy. The majority of cases are found in sub-Saharan Africa. This retrospective cohort study describes characteristics of patients with AIDS-KS and factors associated with mortality in an antiretroviral treatment (ART) program in rural Malawi. Of 11 122 patients enrolled on ART, 830 (7%) had AIDS-KS. Patients with AIDS-KS were more likely to be lost to follow-up (22% versus 14%, P < 0.001) and showed a higher mortality (22% versus 10%, P < 0.001) compared to patients without AIDS-KS. A CD4 count ≤150 cells/μl, advanced stage AIDS-KS, and absence of bleomycin chemotherapy were associated with increased mortality. Earlier diagnosis and improved treatment of AIDS-KS are urgently needed in order to reduce mortality.

HIV-related malignancies pre- and post-highly active antiretroviral therapy: experiences in an inner city tertiary referral centre

With highly active antiretroviral therapy (HAART), AIDS-defining malignancies are becoming less common. The outcomes with standard chemotherapy are improving. In the last 10 years there have been significant changes in our patient demographics due to immigration. The aim of this study was to review the demographics and outcomes of patients with cancer in the post-HAART era and to assess the impact of changing demographics and HAART through comparing them with previously published pre-HAART data from the same centre. A retrospective chart review of 42 patients diagnosed with malignancy from 2000 to 2007 was performed and compared with pre-HAART (1987-1994) data. The incidence of malignancies has decreased from 5.2% to 2.4%. The incidence of Kaposi's sarcoma and primary cerebral lymphoma has decreased. Non-Hodgkin's lymphoma incidence has remained stable, but survival has improved with 44% of patients achieving remission. Non-AIDS-defining malignancies have increased and were associated with longer duration of HIV infection. The change in patient demographics did not have an impact on the type of malignancies diagnosed. Overall the incidence of malignancy has decreased; however, the increase in non-AIDS-defining malignancies highlights the importance of early diagnosis, use of HAART and prospective surveillance.

Impact of infection with human immunodeficiency virus-1 (HIV) on the risk of cancer among children in Malawi - preliminary findings.

BackgroundThe impact of infection with HIV on the risk of cancer in children is uncertain, particularly for those living in sub-Saharan Africa. In an ongoing study in a paediatric oncology centre in Malawi, children (aged ≤ 15 years) with known or suspected cancers are being recruited and tested for HIV and their mothers or carers interviewed. This study reports findings for children recruited between 2005 and 2008.MethodsOnly children with a cancer diagnosis were included. Odds ratios (OR) for being HIV positive were estimated for each cancer type (with adjustment for age (<5 years, ≥ 5 years) and sex) using children with other cancers and non-malignant conditions as a comparison group (excluding the known HIV-associated cancers, Kaposi sarcoma and lymphomas, as well as children with other haematological malignancies or with confirmed non-cancer diagnoses).ResultsOf the 586 children recruited, 541 (92%) met the inclusion criteria and 525 (97%) were tested for HIV. Overall HIV seroprevalence was 10%. Infection with HIV was associated with Kaposi sarcoma (29 cases; OR = 93.5, 95% CI 26.9 to 324.4) and with non-Burkitt, non-Hodgkin lymphoma (33 cases; OR = 4.4, 95% CI 1.1 to 17.9) but not with Burkitt lymphoma (269 cases; OR = 2.2, 95% CI 0.8 to 6.4).ConclusionsIn this study, only Kaposi sarcoma and non-Burkitt, non-Hodgkin lymphoma were associated with HIV infection. The endemic form of Burkitt lymphoma, which is relatively frequent in Malawi, was not significantly associated with HIV. While the relatively small numbers of children with other cancers, together with possible limitations of diagnostic testing may limit our conclusions, the findings may suggest differences in the pathogenesis of HIV-related malignancies in different parts of the world.

Trends in the Incidence of HIV-Related Hematologic Malignancies in the Era of Combination Antiretroviral Therapy and Predictors of HIV-Related Non-Hodgkin's Lymphoma Development and Survival.

Abstract 1916Poster Board I-939 Introduction:Since the introduction of combination antiretroviral therapy (cART), the incidence rates of non-Hodgkin's lymphoma (NHL) and primary central nervous system lymphoma (PCNSL) have declined; however, less is known about the rates of other hematologic malignancies such as Hodgkin lymphoma (HL) and multiple myeloma (MM). We aimed to study changes in the incidence and outcomes of hematologic malignancies (HMs) in the pre- and post-cART eras. Methods:A retrospective analysis of The Ontario HIV Treatment Network Cohort Study (OCS) was performed. The OCS is an ongoing prospective study of HIV-infected adults from 11 sites throughout Ontario, Canada. Incidence rates of HMs were calculated for the pre- (<1997) and post-cART (≥ 1997) eras and compared using Poisson regression analysis. Median survival for each HM was calculated using Kaplan Meier techniques and compared using the logrank test. Predictors of NHL and death from NHL including age, sex, CD4 count, viral load, previous AIDS-defining illness, cART era and duration of HIV infection were evaluated using Cox proportional hazard models. All variables except sex were considered time dependent variables. Results:The OCS database included 4118 individuals with 41978 person-years of follow up over 28 years (1980-2008). There was no significant difference in the incidence of HM in the pre- and post-cART eras (3.6 versus 4.1 cases per 1000 person-years, p-value=0.49) although incidence of PCNSL trended downward (0.8 versus 0.4 cases per 1000 person-years, p-value=0.13) and incidence of HL trended upward (0.1 versus 0.4 cases per 1000 person-years, p-value=0.08). Those with HL had the longest median survival, followed by NHL and PCNSL (63, 39 and 4 months respectively). Predictors of NHL development included low CD4 count, high viral load and pre-cART era. Predictors of death following NHL diagnosis were low CD4 count, previous AIDS-defining illness and longer duration of HIV infection. Conclusion:Since the introduction of cART, the overall incidence of HM has not significantly changed in this cohort. However, as fewer individuals in the cART era develop low CD4 counts, high viral loads and AIDS-defining illnesses, reduced incidence of NHL in this cohort and improved survival following NHL may become apparent. Disclosures:No relevant conflicts of interest to declare.

Human Immunodeficiency Virus–Associated Lung Carcinoma Presenting as Cutaneous Metastases

In the era of highly active antiretroviral therapy (HAART), HIV-positive individuals are increasingly presenting with Non–AIDS-defining cancers such as lung carcinoma. These neoplasms tend to exhibit aggressive clinical behavior and often present with metastatic disease. We present 2 cases of lung carcinoma that manifested initially with cutaneous metastases. Both patients were men (37 and 43 years old) with known AIDS that presented with multiple skin nodules mainly on the trunk (back and shoulder). These cases demonstrate that cutaneous metastases might represent the first sign of an internal HIV-related malignancy. Recognition of skin metastases is important for prompt diagnosis and initiation of proper therapy. With the growing problem of Non–AIDS-defining cancers in the current era of HAART, clinicians should be aware that skin lesions in the HIV-infected individual might represent metastatic disease.

3505 HIV related malignancies: a single centre experience

3505 HIV related malignancies: a single centre experience

How Effective Is ART for AIDS-Related Kaposi Sarcoma?

Kaposi sarcoma (KS) is the most common HIV-related malignancy. To characterize clinical outcomes of HIV-infected patients with KS, researchers analyzed

Stem cell transplantation in HIV-infected patients.

Lymphoma remains a leading cause of mortality in HIV-infected patients. In the HIV-negative setting, high-dose therapy with autologous stem cell transplantation has been a long accepted treatment for certain malignancies such as lymphoma and leukemia. Early transplant trials excluded older patients and patients with comorbidities such as HIV infection. The procedure-related mortality of transplantation, however, has decreased both due to the use of peripheral blood stem cells instead of bone marrow and due to the use of new reduced intensity conditioning regimens. During this same era, the treatment of HIV infection has also become more effective. Patients are no longer dying of opportunistic infections and in addition, their hematologic function has improved. With these advances in HIV therapy, it is possible for HIV-infected patients to mobilize an adequate number of stem cells for an autologous transplant. In addition, with appropriate antiretroviral therapy and infection prophylaxis, the HIV-infected patient can tolerate intensive doses of chemotherapy. This review will summarize clinical trials of autologous stem cell transplantation in HIV-positive patients. Furthermore, the field of solid-organ transplantation has grown to also include HIV-positive patients. The challenges in solid-organ transplantation are similar to allogeneic stem cell transplantation, namely that patients require chronic immunosuppression. This article will also review some of the approaches to allogeneic stem cell transplantation in the HIV-positive patient and provide a rationale for the broader use of stem cell transplantation for appropriate HIV-related hematologic malignancies.

Malignancies in HIV: the Indian scenario

India has the second largest number of HIV/AIDS patients in the world; however, studies done in the area of HIV-related malignancies are few. With the availability of highly active antiretroviral therapy and treatment and prevention of opportunistic infections, an increase in life expectancy of HIV-infected individuals and an increase in HIV-related malignancies is expected. The purpose of this review is to put forth the Indian scenario of HIV-related malignancies. About 2.5 million Indians have HIV/AIDS. Non-Hodgkin's lymphoma and cervical cancer were found to occur in a higher proportion among the HIV-infected individuals in India as compared with non-HIV-infected individuals. The incidence of AIDS-related primary central nervous system lymphoma is low in India. Kaposi's sarcoma is rare in India. Amongst the non-AIDS defining cancers anal cancer, testicular cancer, Hodgkin's disease, colon cancer and certain head and neck cancer sites in men and vaginal cancers among women were found to occur more frequently. With the availability of highly active antiretroviral therapy an increased mortality and morbidity due to neoplastic diseases is expected in the future. As India is a large country and geographically and culturally diverse, large-scale studies need to be done linking the regional cancer centres with the AIDS centres across the country to evaluate the exact burden of HIV-related malignancies.

AIDS related malignancies in Brazil

There have been relatively few studies of HIV-related malignancies in Brazil. Universal access to antiretroviral drugs in Brazil has changed both the mortality and morbidity rates of AIDS. Nevertheless, there is also extreme poverty in both urban and rural areas and complications of prolonged immune suppression such as mycobacterial and malignant diseases have put a significant strain on the country's healthcare system. This brief review outlines the existing data regarding AIDS related malignancies in the largest Latin American country. Currently, there are almost 600 000 people infected with HIV in Brazil and 170,000 patients are receiving highly active antiretroviral therapy. In the studies done of HIV malignancies in Brazil, it appears that these tumors are histologically similar to those that occur in other equatorial countries and differ somewhat from those seen in Europe and the US. Another unique distinction is the high association with oncogenic herpes viruses. The existence of federally sponsored highly active antiretroviral therapy, clinicians and healthcare providers experienced in the care of HIV patients and high incidence of malignancies associated with oncogenic viruses make Brazil an important site for clinical and basic research in AIDS and immunodeficiency related malignancies.

Plasmablastic Lymphoma Presenting as a Gingival Growth in a Previously Undiagnosed HIV-Positive Patient: A Case Report

Since the appearance of AIDS, there has been a significant increase in the number of cases of non-Hodgkin’s lymphoma (NHL), which is the second most common HIV-related malignancy after Kaposi’s sarcoma. 1 Porter S.R. Dios P.D. Kumar N. et al. Oral plasmablastic lymphoma in previously undiagnosed HIV disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 87: 730 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar The risk of NHL is 60 times greater in patients with HIV disease than in otherwise healthy persons. 2 Beral V. Peterman T. Berkelman R. et al. AIDS-associated non-Hodgkin’s lymphoma. Lancet. 1990; 337: 805 Abstract Scopus (566) Google Scholar

Oncologic Complications of Human Immunodeficiency Virus Infection: Changing Epidemiology, Treatments, and Special Considerations in the Era of Highly Active Antiretroviral Therapy

Although highly active antiretroviral therapy (HAART) has revolutionized the treatment of human immunodeficiency virus (HIV)-positive patients, malignancies in the setting of HIV infection remain an appreciable problem. We evaluated the changing epidemiology of HIV-related malignancies, optimal neoplastics and their effect on viral dynamics, and evidence regarding drug interactions between chemotherapy and antiretrovirals. A MEDLINE search (January 1966-June 2006) was performed to identify clinical trials, review articles, and meta-analyses; abstracts from HIV conferences were also searched. Survival of patients with HIV-related malignancies has substantially improved since the advent of HAART. Chemotherapy for malignancies in the HIV-positive population generally resembles that for the HIV-negative population, with trials revealing an elevated frequency of toxicities in HIV-positive patients. Studies of antineoplastics have shown no long-term adverse effects on viral dynamics in terms of immunologic or virologic HIV markers. Limited pharmacokinetic data with antineoplastics and antiretrovirals suggest possible changes in some pharmacokinetic parameters, but these results should be interpreted cautiously because of the small numbers of patients enrolled in the trials. Researchers also report an increased frequency of chemotherapy-related toxicities when HAART was coadministered with antineoplastics. This increase was likely due to impairment of cytochrome P450 metabolism of antineoplastics by protease inhibitors. Because of the survival benefits of HAART, the integration of antiretrovirals with chemotherapy is now preferred for patients with HIV-related malignancies. However, because the metabolic pathways of many of these agents are similar, the effectiveness of antineoplastic therapy and its related toxicities should be vigilantly monitored in this patient population.