[Current status and challenges of AIDS-related malignant lymphoma]

AIDS-related malignant lymphomas (ARL) are lymphomas that develop in association with HIV infection. Although the introduction of combination antiretroviral therapy (cART) has markedly improved the life expectancy of people living with HIV (PLWH), approximately one-third of PLWH, including some with well controlled disease, still die from HIV-associated malignancies. HIV itself is not tumorigenic, and most of these tumors are due to co-infection with oncogenic viruses. Epstein-Barr virus (EBV) and Kaposi sarcoma-associated herpesvirus (KSHV) are the most important risk factors for ARL, and immunodeficiency, chronic inflammation, accelerated aging, and genetic instability associated with HIV infection are thought to promote lymphomagenesis. When ARL is treated with cART, its prognosis is now comparable to that in patients without HIV. Intensive chemotherapy with autologous stem cell transplantation is also available for relapsed/refractory ARL. Since early-stage HIV infection has no symptoms, significant numbers of HIV-infected individuals do not notice HIV infection until the onset of AIDS. In Japan, this is called "ikinari AIDS" (sudden AIDS), and accounts for more than 30% of all cases. Hematologists should carefully consider the possibility of HIV infection in patients with lymphoma. Even in the cART era, ARL remains an important problem in PLWH, warranting continuous surveillance.