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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virology. Aug 12, 2015; 4(3): 209-218
Published online Aug 12, 2015. doi: 10.5501/wjv.v4.i3.209
Non-acquired immunodeficiency syndrome definings malignancies among human immunodeficiency virus-positive subjects: Epidemiology and outcome after two decades of HAART era
Pierluigi Brugnaro, Erika Morelli, Francesca Cattelan, Andrea Petrucci, Sandro Panese, Franklyn Eseme, Francesca Cavinato, Andrea Barelli, Enzo Raise
Pierluigi Brugnaro, Erika Morelli, Francesca Cattelan, Andrea Petrucci, Sandro Panese, Franklyn Eseme, Francesca Cavinato, Andrea Barelli, Enzo Raise, Infectious Diseases Department, Civil Hospital “SS.Giovanni e Paolo”, 6776-30122 Venice, Italy
Author contributions: Brugnaro P and Raise E designed the format of the manuscript; Brugnaro P, Morelli E, Cattelan F, Petrucci A, Panese S, Eseme F, Cavinato F and Barelli A contributed equally to write the paper; and Brugnaro p revised the manuscript before submission.
Conflict-of-interest statement: The authors state that there is not conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Pierluigi Brugnaro, Infectious Diseases Department, Civil Hospital “SS.Giovanni e Paolo”, Castello, 6776-30122 Venice, Italy. brugnarop@yahoo.com
Telephone: +39-41-5294886 Fax: +39-41-5294884
Received: November 27, 2014
Peer-review started: November 28, 2014
First decision: January 20, 2015
Revised: March 2, 2015
Accepted: May 27, 2015
Article in press: May 28, 2015
Published online: August 12, 2015
Processing time: 258 Days and 14.4 Hours
Abstract

Highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infection has been widely available in industrialized countries since 1996; its widespread use determined a dramatic decline in acquired immunodeficiency syndrome (AIDS)-related mortality, and consequently, a significant decrease of AIDS-defining cancers. However the increased mean age of HIV-infected patients, prolonged exposure to environmental and lifestyle cancer risk factors, and coinfection with oncogenic viruses contributed to the emergence of other malignancies that are considered non-AIDS-defining cancers (NADCs) as a relevant fraction of morbidity and mortality among HIV-infected people twenty years after HAART introduction. The role of immunosuppression in the pathogenesis of NADCs is not well defined, and future researches should investigate the etiology of NADCs. In the last years there is a growing evidence that intensive chemotherapy regimens and radiotherapy could be safely administrated to HIV-positive patients while continuing HAART. This requires a multidisciplinary approach and a close co-operation of oncologists and HIV-physicians in order to best manage compliance of patients to treatment and to face drug-related side effects. Here we review the main epidemiological features, risk factors and clinical behavior of the more common NADCs, such as lung cancer, hepatocellular carcinoma, colorectal cancer and anal cancer, Hodgkin’s lymphoma and some cutaneous malignancies, focusing also on the current therapeutic approaches and preventive screening strategies.

Keywords: Human immunodeficiency virus infection; Malignancy; Highly active antiretroviral therapy; Non-acquired immunodeficiency syndrome-defining cancers

Core tip: Since the introduction of highly active antiretroviral therapy (HAART) the incidence of acquired immunodeficiency syndrome (AIDS)-defining diseases has declined. This has resulted in a significant improvement in survival of human immunodeficiency virus (HIV)-infected patients. However the incidence of non-AIDS defining cancers (NADCs) did not decrease, and this determines now a relevant burden of mortality among HIV-positive patients. The availability of an even more effective HAART along with chemotherapy and radiotherapy regimens suitable also for HIV-patients could improve the outcome of these patients in the setting of NADCs. Screening interventions to detect precancerous lesions are also of paramount importance in order to decrease mortality of NADCs.