Oncological problems in AIDS--a review of the clinical features and management

Since the beginning of the acquired immunodeficiency syndrome (AIDS) epidemic in the early 1980s, several malignant conditions have been recognised to be associated with this syndrome which affect up to 40% of AIDS patients at some stage of their illness. They include Kaposi's sarcoma, systemic non-Hodgkin's lymphoma, primary central nervous system lymphoma and invasive cervical cancer. Kaposi's sarcoma and primary central nervous system lymphoma were tumours rarely seen below the age of 50 prior to the epidemic and therefore were recognised early to be AIDS-related conditions. However, systemic non-Hodgkin's lymphoma and invasive cervical cancer were only recognised when sufficient epidemiological evidence became available to indicate an increased incidence of these conditions amongst the HIV-infected population. In the presence of immunosuppression, the biological behaviour of these conditions are significantly altered with a more advanced stage at presentation, a more aggressive disease course and poorer responses to treatment. There is evidence that in each of these malignant conditions, an additional viral infection may be responsible for their pathogenesis. Kaposi's sarcoma-associated herpes virus is implicated in the development of Kaposi's sarcoma, Epstein-Barr virus in systemic non-Hodgkin's lymphoma as well as primary central nervous system lymphoma and human papilloma virus in invasive cervical cancer. Developing effective treatment strategies with minimal toxicity for these patients remains the greatest challenge as they often have serious coexisting illnesses and tolerate chemotherapy poorly because of insufficient bone marrow function reserve.