Cancers in People with HIV and AIDS: Progress and Challenges

The association between AIDS and cancer was recognized from the beginning of the AIDS epidemic, when the appearance of Kaposi sarcoma in a cluster of young men was one of the first signs of this new disease. It was soon recognized that AIDS was caused by infection with a novel virus (HIV) and that AIDS patients are prone to develop a number of “AIDS-defining” cancers: Kaposi sarcoma, lymphoma, and cervical cancer. The development of effective combination anti-HIV therapy starting around 1996 converted AIDS from a death sentence to a manageable disease and led to dramatic shifts in the epidemic. As this therapy was able to improve immune function in patients, the incidence of most “AIDS-defining” cancers decreased. There is a misconception, however, that AIDS has gone away. In fact, as AIDS patients are living longer, the number of AIDS patients has more than doubled in the United States since 1996, and the AIDS population overall has increased in age. Also, as AIDS patients are less likely to die of other complications, cancer is coming to the forefront as one of the most common causes of death in regions where AIDS drugs are widely available. Moreover, the three “AIDS-defining” cancers are now taking a back seat to a number of other HIV-associated cancers, such as Hodgkin lymphoma, lung cancer, and anal cancer. In the developing world, AIDS-associated cancers are a major public health problem, and in some regions of sub-Saharan Africa, Kaposi sarcoma is the most common tumor in men.

In recent years, there has been a vast increase in our understanding of HIV-associated cancers. We now know, for example, that most are caused by other viruses and that the main role of HIV and immunodeficiency is to provide a supportive environment for the viruses to multiply and for the cancers to develop. But there remain a number of unanswered questions and a need for improved prevention and therapy. In the 28 chapters of this book, written by some of the most renowned experts in this field, we present up-to-date information on the cancers associated with HIV infection. The chapters cover the epidemiology of these cancers, their pathogenesis, their clinical presentation, and their treatment. The book will be of value to physicians, other medical professionals, students, and researchers with an interest in AIDS, viral-associated cancers, or HIV-associated malignancies.

TABLE OF CONTENTS

1. HIV-associated Cancers: Overview

Robert Yarchoan, Thomas Uldrick, Mark Polizotto

2. Epidemiology of AIDS-defining Malignancies

William A. Blattner and Rebecca G. Nowak

3. Epidemiology of non-AIDS Defining Malignancies

Andrew E. Grulich

4. HIV Cancers in Resource-Limited Regions

Sam M. Mbulaiteye

5. Kaposi's Sarcoma-associated Herpesvirus (KSHV)

Blossom Damania and Dirk P. Dittmer

6. Epstein Barr Virus (EBV)

Lindsey Hutt-Fletcher

7. Human Papillomavirus (HPV)

Zhi-Ming Zheng

8. Merkel Cell Polymavirus (MCV)

Nicole Fischer and Adam Grundhoff

9. Presentation and Pathogenesis of Kaposi's Sarcoma

Corey Casper

10. Management of Kaposi's Sarcoma

Susan E. Krown

11. Presentation and Pathogenesis of HIV Lymphomas

Richard F. Little, Stefania Pittaluga, Kieron Dunleavy

12. Diffuse Large B-Cell Lymphoma

Neel K. Gupta and Lawrence D. Kaplan

13. Burkitt and Burkitt-Like Lymphoma

Kishor Bhatia and Sam M. Mbulaiteye

14. Primary Effusion Lymphoma

Giovanna Tosato

15. AIDS-related Central Nervous System Lymphoma

Jan Davidson-Moncada and Thomas Uldrick

16. Plasmablastic and Other Lymphomas

Huan-You Wang, Ida Wong-Sefidan, Erin Reid

17. Hodkin Lymphoma

Michele Spina, Rosanna Ciancia, Accursio Augello

18. Multicentric Castelman Disease

Mark N. Polizzotto, Thomas S. Uldrick, Robert Yarchoan

19. Cervical Cancer

Elizabeth A. Stier

20. Anal Cancer

Joel Palefsky

21. Other HPV-Associated Cancers

Kristina R. Dahlstrom and Erich M. Sturgis

22. Lung Cancer in HIV Infection

Deepthi Mani and David M. Aboulafia

23. Hepattocellular Carcinoma in HIV-positive Patients

Massimiliano Berretta, Paolo De Paoli, Umberto Tirelli, Bruno Cacopardo

24. Merkel Cell Carcinoma and Other HIV-associated Skin Cancers

Nathalie C. Zeitouni adn Bethany Lema

25. Conjuctival Carcinoma

Kenneth O. Simbiri and Erle S. Robertson

26. Malignancies in Children with HIV Infection

D. Cristina Stefan

27. cART and Supportive Care

Ronald T. Mitsuyasu

28. Stem Cell Transplantation

Christine Durand and Richard Ambinder

The association between AIDS and cancer was recognized from the beginning ofthe AIDS epidemic, when the appearance of Kaposi sarcoma in a cluster of youngmen was one of the first signs of this new disease. It was soon recognized that AIDSpatients are prone to develop a number of AIDS-defining cancers: Kaposi sarcoma,lymphoma, and cervical cancer. The development of effective combination anti-HIVtherapy starting around 1996 converted AIDS from a death sentence to a manageabledisease and led to dramatic shifts in the epidemic. As this therapy was able to improveimmune function in patients, the incidence of most AIDS-defining cancers decreased.There is a misconception, however, that AIDS has gone away. In fact, as AIDS patientsare living longer, the number of AIDS patients has more than doubled in the UnitedStates since 1996, and the AIDS population overall has increased in age. Also, as AIDSpatients are less likely to die of other complications, cancer is coming to the forefront as one of the most common causes of death in regions where AIDS drugs are widelyavailable.Moreover, the three AIDS-defining cancers are now taking a back seat toa number of other HIV-associated cancers, such as Hodgkin lymphoma, lung cancer,and anal cancer. In the developing world, AIDS-associated cancers are a major publichealth problem, and in some regions of sub-Saharan Africa, Kaposi sarcoma is themost common tumor in men.

In recent years, there has been a vast increase in our understanding of HIV-associatedcancers. We now know, for example, that most are caused by other viruses and thatthe main role of HIV and immunodeficiency is to provide a supportive environmentfor the viruses to multiply and for the cancers to develop. But there remain a numberof unanswered questions and a need for improved prevention and therapy. In the 28chapters of this book, written by some of the most renowned experts in this field, wepresent up-to-date information on the cancers associated with HIV infection. Thechapters cover the epidemiology of these cancers, as well as their pathogenesis, clinicalpresentation, and treatment.

Dr. Robert Yarchoanis the Director of the Office of HIV and AIDS Malignancy andChief of the HIV and AIDS Malignancy Branch in the National Cancer Institute. Heplayed a major role in developing the first AIDS drugs. His research is now focused onAIDS-related cancers, especially Kaposi sarcoma and other cancers caused by Kaposisarcoma-associated herpesvirus.