Chapter 52: The Acquired Immunodeficiency Syndrome–Related Cancers

KEY CONCEPTS

• One million, two-hundred thousand people in the United States (0.3%) were living with HIV in 2018; however, more than 36,000 new infections occurred, and an estimated 1 in 7 (14%) of those with the diagnosis were not aware of it. Forty-five percent of those with new diagnoses identified as Black or Latino. According to World Health Organization (WHO) statistics from 2018, the prevalence globally has not statistically changed among adults 15 to 49 years of age since 2014, and the prevalence is as high as 21% in sub-Saharan Africa (Botswana).

• Classically, Burkitt and aggressive B-cell lymphomas have been AIDS-defining malignancies. Although not originally described as HIV-related, other categories of lymphomas are now identified in the WHO classification as occurring in patients with HIV seropositivity include peripheral T-cell, marginal zone, and Hodgkin lymphoma (HL) subtypes, as well as primary effusion and plasmablastic lymphomas, and others. Cervical carcinoma is the only AIDS-defining cancer; however, other cancers increased in patients with HIV seropositivity include lung cancers and anal carcinomas in men.

• In the post–highly active antiretroviral therapy (HAART) era, there has been a reduction in the incidence of various lymphoma subtypes, including primary central nervous system (CNS) and systemic high-grade B-cell lymphomas, and Kaposi sarcoma (KS), but other lymphoma subtypes have not decreased, including Hodgkin and Burkitt lymphomas.

• Human herpesvirus 8 is responsible for KS, and, as in patients without HIV seropositivity, Epstein-Barr virus (EBV) in some patients with aggressive B-cell and Burkitt lymphomas and human papillomavirus in cervical carcinoma. Other agents associated with these cancers are unknown.

• Patients with advanced HL (stages III–IV) and known HIV disease should receive brentuximab vedotin plus adriamycin/vinblastine/dacarbazine chemotherapy. Limited-stage disease may be treated with therapy as for patients who are seronegative.

• Without the availability of randomized studies, EPOCH-R, tailored to disease extent with number of cycles of therapy adjusted to early positron emission tomography (PET) results, is the preferred regimen for treatment of patients with high-grade lymphomas; this combination is also recommended for those with Burkitt lymphomas, and those with other aggressive lymphoproliferative disorders.