Therapeutic approaches to neoplasms in AIDS

The multifactorial etiology of Kaposi's sarcoma (KS), which is seen primarily in men, includes genetic predisposition and immunosuppression. Recently, the KS seen in association with human immunodeficiency virus (HIV) infection has been shown to be mediated by the production of certain growth factors. HIV per se may also play an etiologic role via its tat gene. Therapeutic options include irradiation for local or cosmetic control, interferon-alpha, combinations of antiretroviral agents and interferon-alpha, and chemotherapy. The use of antineoplastic agents, either individually or in combination, in cases of advanced disease has been somewhat successful, but resultant immunosuppression and neutropenia may predispose patients to further infection, thereby adversely affecting survival. AIDS-related lymphoma, a late manifestation of HIV infection, often presents with widespread extranodal disease; the median survival time in all series has been approximately 6 months. Two-thirds of patients may have central nervous system involvement at some time in the course of illness. Intensive chemotherapeutic regimens are associated with an increased likelihood of opportunistic infection and do not prolong survival. Combinations of antineoplastic agents given at low doses for short periods may be associated with long-term remissions.