Malignant tumours in patients with HIV infection

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Umberto Tirellia,
Silvia Franceschia,
Antonino Carbonea

division of medical oncology and AIDS
epidemiology unit
^a Centro Regionale di Riferimento Oncologico, Istituto Nazionale di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy
division of pathology Series editor: G M Mead (G M Mead is consultant in medical oncology at the Cancer Research Campaign's Wessex Medical Oncology Unit)

Correspondence to: Dr Tirelli.

One of the most important though somewhat neglected aspects of research in HIV infection concerns the development, clinicopathological characteristics, and treatment of malignant tumours in infected patients. With the improved survival of patients with AIDS owing to the better prevention and treatment of infectious complications there may well be an increase in AIDS related malignancies. This paper reviews the epidemiology, pathology, and treatment of malignant tumours in patients with HIV.

This is the seventh in a series of articles examining developments in cancer and updating what we know about the disease

What are the main types of cancer in AIDS?

At least two malignancies are firmly established as associated with HIV and have long been diagnostic of AIDS--namely, Kaposi's sarcoma and non-Hodgkin's lymphoma (table). When compared with the general population in the same area, the risk of Kaposi's sarcoma in men with AIDS was roughly 900-fold greater in the State of Illinois1 and 700-fold greater in San Francisco Bay.2 Data from the same cancer registry linkage studies for non-Hodgkin's lymphoma showed standardised incidence ratios of 1411 and 712 respectively (table). More detailed analyses by subtype of non-Hodgkin's lymphoma suggested that the standardised incidence ratio in single men aged 20-49 in 1985-7 as compared with 1973-8 was 43 for the extranodal form but only 8 for nodal disease.3 With respect to histological grade, the increased standardised incidence ratio was restricted to intermediate and high grade lymphomas.3

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Risk of cancer in men with AIDS or at risk of AIDS

In the largest cancer registry linkage study2 solid tumours as a whole did not occur more often than expected among patients with AIDS, but two types of cancer which are not part of the AIDS case definition occurred with significantly increased frequency. These were Hodgkin's disease (standardised incidence ratio 8.8) and cancers of the rectum, …