Non-Hodgkin's lymphomas and other malignancies in the acquired immune deficiency syndrome

Approximately 95% of neoplasms in acquired immune deficiency syndrome (AIDS) patients are either Kaposi's sarcoma or non-Hodgkin's malignant lymphoma. Kaposi's sarcoma is by far the most prevalent malignancy found, although a marked increase in the incidence of predominantly high-grade B cell malignant lymphomas has also been reported. There is evidence suggesting a correlation between Epstein-Barr virus (EBV) and the high incidence of lymphomas, and the most plausible explanation for this is the ability for EBV to cause ongoing B cell proliferation. Other agents have also been studied as potential cofactors in the induction of B cell lymphomas or Kaposi's sarcoma in AIDS patients, including cytomegalovirus and nitrites. Their precise roles remain speculative, however, and further study is needed. At this time there is no evidence of a cause-and-effect relationship between human immunodeficiency virus (HIV)-infected patients and Hodgkin's disease, nor is there epidemiologic data to suggest that Hodgkin's disease is related to AIDS. Other neoplasms that have been described in HIV-infected individuals include cloacogenic anorectal carcinoma and squamous-cell carcinoma of the head, neck, and oral cavity, but there is currently no epidemiologic evidence to prove that these cancers are part of the spectrum of AIDS. Although complete remission may be achieved using standard chemotherapeutic regimens, these remissions are not durable in the majority of patients.