Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
Clinical management of HIV-related malignancies.
Annu Conf Australas Soc HIV Med. 1993 Oct 28-30;5:23 (abstract no. FPI-3). Unique Identifier : AIDSLINE ASHM5/94348940 Volberding P; San Francisco General Hospital.
Abstract:
Two cancers are recognised as occurring in a higher rate in patients with HIV infection. These include non-Hodgkin's B cell lymphomas and Kaposi's sarcoma. In addition, some data indicates that Hodgkin's disease may also occur at an increased incidence. Many other malignancies have been reported in patients infected with HIV and the natural history of these malignancies may well be altered in the setting of a viral-induced immune deficiency. Kaposi's sarcoma remains the most common HIV-related malignancy, although its incidence is decreasing in all populations. Kaposi's sarcoma appears from epidemiologic evidence to be induced by a second pathogen in addition to HIV, although the nature of this probably enteric infection is unknown. The diagnosis of Kaposi's sarcoma ideally is made both visually and histologically as other conditions, especially bacillary angiomatosis can closely resemble this malignancy. Therapy for Kaposi's sarcoma is individualised. Slowly progressing disease may not require systemic treatment and local therapies can be used for facial lesions in particular. Systemic chemotherapy with vinca alkaloids is often used for early disease while more aggressive disease, especially involving the lungs, requires more aggressive combination chemotherapy, typically with combinations of adriamycin, bleomycin and vincristine. Newer biologic therapies are being developed. Non-Hodgkin's lymphomas in HIV infection occur at an increased rate and two main types of lymphomas are seen. These include central nervous system disease and peripheral non-Hodgkin's lymphomas. Central nervous systems lymphomas are essentially all EBV-related and occur in patients with severely depleted CD4 cell count. Peripheral lymphomas occur in patients with a more intact immune system and many are not EBV-associated. Peripheral B cell lymphomas in HIV are often extra nodal and disseminated and respond less completely to therapy than in the HIV uninfected patient. Aggressive chemotherapy is required although a bone marrow tolerance for aggressive chemotherapy is frequently dose-limiting. Therapy of HIV-related non-Hodgkin's lymphomas has been improved with the availability of bone marrow growth factor support, especially GCSF. The treatment of CNS lymphomas in HIV infection is, at best palliative. Radiation therapy is used, although survival is limited and response to therapy is often incomplete. Other malignancies in HIV infection, while not necessarily occurring at an increased incidence, have a more aggressive clinical course. The most important of these malignancies include cervical malignancies in women and anal squamous cell carcinomas in men. Routine cytologic examination for these cancers should be included in HIV management and these and other cancers should be treated as appropriate but considering the patient's disease stage.
Keywords: Antineoplastic Agents, Combined/THERAPEUTIC USE Anus Neoplasms/THERAPY Carcinoma, Squamous Cell/THERAPY Cervix Neoplasms/THERAPY Chemotherapy, Adjuvant Combined Modality Therapy Female Human HIV Infections/*THERAPY Lymphoma, AIDS-Related/THERAPY Male Neoplasms/*THERAPY Sarcoma, Kaposi's/THERAPY Skin Neoplasms/THERAPY ABSTRACT 941230
M94C4287
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Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
