Pulmonary manifestations of acquired immunodeficiency syndrome-associated malignancies

Significant progress has been made in the treatment and prophylaxis of human immunodeficiency virus (HIV)-associated infections. As patients with HIV infection live longer, more cases with HIV-associated malignancies are being reported. Pulmonary complications of HIV-associated Kaposi's sarcoma and non-Hodgkin's lymphoma present clinicians with diagnostic and therapeutic challenges. Pulmonary involvement with Kaposi's sarcoma ranges from 6% to 32%. Pulmonary involvement with acquired immunodeficiency syndrome (AIDS)-related non-Hodgkin's lymphoma occurs in about 8% of cases. Symptomatic pulmonary involvement, although unusual, may necessitate aggressive intervention with chemotherapy or radiation therapy. Although survival benefit has not been seen with aggressive therapy, significant palliation of symptomatic disease has been noted. Other non-AIDS-associated malignancies in HIV-infected patients, including Hodgkin's disease and bronchogenic carcinoma, have been reported in several series. Although no conclusive epidemiological data have yet linked HIV disease with the development of these malignancies, some investigators indicate that these cancers have an altered natural history in the HIV-infected patient. A more thorough understanding of the mechanisms by which HIV alters host immunity, predisposing the host to these malignancies, will afford new insight into ways to treat these life-threatening complications of HIV disease.