AIDS-related malignancies: revisited

Since the first reports between the association of Human Immunodeficiency Virus (HIV) infection and neoplasia, there has been a dramatic change in the incidence and epidemiology of AIDS-related malignancies. Kaposi sarcoma (KS), non-Hodgkin's lymphomas (NHL), and cervical cancer are classified by the Centers for Disease Control and Prevention (CDC) as AIDS-defining malignancies. However, since the availability of highly active combination antiretroviral therapy (cART), especially protease inhibitors, there has been a steady increase in non- AIDS defining malignancies, such as Hodgkin's lymphoma (HL), lung cancer, hepatocellular cancer, anal cancer and others and a decline in AIDS-defining neoplasias. Although the emergence of non-AIDS defining cancers could be a result of longer life expectancy and due to a better control of HIV, toxic habits and co-infection with other viruses such as hepatitis B, hepatitis C and human papilloma virus (HPV) could play an important role. The interactions of cART and incomplete immune reconstitution could be other factors explaining the increase in non-AIDS defining cancers. These emerging non-AIDS defining malignancies present a new challenge in the care of patients with HIV infection, and require optimal treatment protocols that take into consideration the interaction between cART and systemic chemotherapy. We review the current status of AIDS-related malignancies, its pathophysiology, epidemiology and management with emphasis in the changing patterns of presentation.