The epidemiology of AIDS-related malignancies

Immunosuppression resulting from HIV infection does not explain the unique distribution of Kaposi's sarcoma across risk groups. A majority of cases occur among homosexual men, particularly those with oral-anal contact, those with sexual contacts in high-risk cities, and those frequently use nitrite inhalants, suggesting a currently unidentified etiologic cofactor. Risk of non-Hodgkin's lymphoma among HIV-infected persons continues to increase over time. Because all HIV-infected groups are at high risk of non-Hodgkin's lymphoma, environmental cofactors may be less important in the disease's etiology. Because data on risk factors for AIDS-related non-Hodgkin's lymphoma are limited, further studies are needed. Cohort studies suggested that the risk of Hodgkin's disease is greater among HIV-infected persons; however, the number of cases reported has been small. Hodgkin's disease occurring among HIV-infected persons is more aggressive than and differs in presentation from that among noninfected persons. The addition of invasive cervical cancer to the US Centers for Disease Control definition of AIDS is based on data showing that HIV-infected women have a high prevalence of cervical disease. Although no conclusions can yet be drawn regarding the temporal relationship of cervical disease and HIV infection, there is evidence of a direct relationship between the degree of HIV-induced immunosuppression and the extent of cervical disease. Other cancers are being diagnosed among AIDS patients, and monitoring of the risk of solid tumors among various cohorts of high-risk and HIV-infected persons continues.