AIDS-defining cancers in patients infected with HIV are
Lymphoma, immunoblastic (or equivalent term)
Lymphoma, primary, of central nervous system
Cervical cancer, invasive
Other cancers that appear to be dramatically increased in incidence or severity include
Hodgkin lymphoma (especially the mixed cellularity and lymphocyte-depleted subtypes)
Other skin and superficial eye cancers
Leiomyosarcoma is a rare complication of HIV infection in children. Also, the rates of other common cancers (eg, lung, head and neck, and cervical carcinomas; hepatomas) are several times higher in patients with HIV infection than in the general population. This finding may reflect, at least in part, greater exposure to the viruses or toxins that cause these cancers: hepatitis B and C for hepatoma; human papillomavirus for cervical, anal, penile, and oropharyngeal carcinoma; and alcohol and tobacco for lung and head and neck carcinomas.
(See also Human Immunodeficiency Virus (HIV) Infection.)
Non-Hodgkin lymphoma
Incidence of non-Hodgkin lymphoma is 50 to 200 times higher in patients with HIV infection. Most cases are B-cell, aggressive, high-grade histologic subtype lymphomas. At diagnosis, extranodal sites are usually involved; they include bone marrow, gastrointestinal tract, and other sites that are unusual in non–HIV-associated non-Hodgkin lymphoma, such as the central nervous system and body cavities (eg, pleural, pericardial, peritoneal).
Common presentations include rapidly enlarging lymph nodes or extranodal masses and systemic symptoms (eg, weight loss, night sweats, fevers).
Diagnosis of non-Hodgkin lymphoma is by biopsy with histopathologic and immunochemical analysis of tumor cells. Abnormal circulating lymphocytes or unexpected cytopenias suggest involvement of the bone marrow, mandating bone marrow biopsy. Tumor staging may require cerebrospinal fluid examination and CT or MRI of the chest, abdomen, and other areas where tumors are suspected.
Poor prognosis is predicted by the following:
CD4 count < 100/mcL
Age > 35 years
Poor functional status
Bone marrow involvement
History of opportunistic infections
High-grade histologic subtype
Treatment
Primary central nervous system lymphoma
Incidence of primary central nervous system lymphoma is markedly increased in patients with HIV infection with very low CD4 counts.
Primary central nervous system lymphomas consist of intermediate- or high-grade malignant B cells, originating in central nervous system tissue. These lymphomas do not spread systemically, but the prognosis is poor; median survival is < 6 months.
Presenting symptoms include headache, seizures, neurologic deficits (eg, cranial nerve palsies), and mental status changes.
Acute treatment
Cervical cancer
In women with HIV, prevalence of human papillomavirus (HPV) infection is increased, oncogenic subtypes (types 16, 18, 31, 33, 35, and 39) persist, the incidence of cervical intraepithelial neoplasia (CIN) is up to 60%, and the incidence of cervical cancer is increased (1). However, cervical cancers, if they occur, are more extensive, are more difficult to cure, and have higher recurrence rates after treatment.
The risk of cervical cancer in women with HIV increases with poorly controlled disease, including high viral load, low CD4 count, or insufficient response to ART.
Management methods for CIN or cervical cancer is not changed by HIV infection. Frequent Papa tests are important to monitor for progression of CIN. ART may result in resolution of HPV infection and regression of CIN but has no clear effects on cancer.
Squamous cell carcinoma of the anus or vulva
Squamous cell carcinoma of the anus and squamous cell carcinoma of the vulva are caused by the same oncogenic types of HPV as cervical cancers and occur more commonly in patients with HIV infection. The increased incidence of anal intraepithelial neoplasia and cancers in these patients appears to be caused by both high-risk behaviors (eg, anal-receptive intercourse) and immunosupression by HIV; ART may decrease risk of progression.
Anal dysplasia is common, and squamous cell cancers can be very aggressive.
Treatments
Reference
1. Stelzle D, Tanaka LF, Lee KK, et al: Estimates of the global burden of cervical cancer associated with HIV [published correction appears in Lancet Glob Health 9(2):e119, 2021]. Lancet Glob Health 9(2):e161-e169, 2021. doi:10.1016/S2214-109X(20)30459-9
