Like HIV, certain other viruses — such as HPV (human papilloma virus) and HHV-8 (human herpes virus-8) — are also sexually transmitted. Therefore, it should come as no surprise that some HIV positive people who also test positive for these other viruses can develop certain cancers caused by HPV (cervical and anal cancer) and HHV-8 (Kaposi's sarcoma).
The cause of another AIDS-related cancer, non-Hodgkin's lymphoma, is more puzzling. In people whose immune systems have been attacked by HIV, the risk of developing lymphoma is about 100 times greater than that of HIV negative people. It is not clear why HIV positive people have an increased risk for lymphoma but not any number of other strange cancers. One theory is that certain immune cells called B-cells are over stimulated by HIV and a common virus called EBV (Epstein-Barr virus). Eventually some of the over-stimulated B-cells in lymph nodes and tissues turn into tumours.
There isn't any specific sign or symptom that indicates a person has lymphoma. Symptoms can vary depending on the location and number of the tumour(s). In some people, there may be as few symptoms as fatigue and swollen lymph nodes. In others there may be headache or seizures, fever, night sweats and unintentional weight loss. To help diagnose lymphoma, magnetic (NMR) and X-ray (CAT) scans can be useful, as are analyses of spinal fluid and tumour samples.
In the time before protease inhibitors (PIs), prospects for survival after a diagnosis of lymphoma in PHAs were not encouraging. On average, PHAs survived about six months after a diagnosis of this cancer. The use of combination anti-HIV therapy that includes a PI or non-nuke appears to have greatly increased the chance of survival for PHAs who have lymphoma. This is because PIs increase CD4+ counts and decrease the risk of developing AIDS-related infections. Such an effect is important because before HAART was available PHAs with lymphoma often died from infections brought about because of chemotherapy's impact on their bone marrow and immune system.
However, despite the decreased risk of AIDS-related infections in users of highly active antiretroviral therapy (HAART), most studies have not found a significant decrease in the risk of developing lymphoma among HAART-users. A recently published study from France may be an exception and we report their findings next.
REFERENCES
1. Sparano JA. Clinical aspects and management of AIDS-related lymphoma. European Journal of Cancer 2001;37:1296-1305.
2. McCain KL. Epstein-Barr virus and HIV-AIDS-associated diseases. Biomedicine and Pharmacotherapy 2001;55:348-352.
3. Blaschke S, Hannig H, Buske C, et al. Expression of Simian Epstein-Barr virus-encoded latent membrane protein-1 in malignant lymphomas of SIV-infected Rhesus macaques. Journal of Medical Virology 2001;65:114-120.
4. van Baarle D, Hovenkamp E, Callan MFC, et al. Dysfunctional Epstein-Barr virus (EBV)-specific CD8+ T lymphocytes and increased EBV load in HIV-1-infected individuals progressing to AIDS-related non-Hodgkin's lymphoma. Blood 2001;98(1):146-155.
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Copyright © 2001 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284 http://www.catie.ca.
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