Published in Cancer Detection and Prevention 1998; 22(Supplement 1).

Aids-related cancer

HL Ioachim, MD

In the past few years the disease patterns of AIDS have shown significant changes. The survival of AIDS patients has increased as a result of antiretroviral therapy and a better control of opportunistic infections. However, a longer survival appears to be associated with an increased risk of malignancies which is now estimated to more than 40%. Not all types of neoplasms, just as not all kinds of infectious diseases, have increased their occurrence in the population of long survivors. So far, population based studies have shown a significant increase in the incidence of three types of neoplasms: Kaposi sarcoma, non-Hodgkin’s lymphoma, and aria-genital tumors. However, in the future new treatments and lengthened survivals may reveal yet other neoplasms associated with AIDS. Kaposi sarcoma (KS) a rare neoplasm in the general population had a decade ago an incidence as high as 40% among AIDS patients, While its frequency is about 36% in homosexual AIDS patients, it is only 4.3% among intravenous drug addicts and 1 % in hemophiliacs with AIDS. The high incidence of KS in homosexual AIDS patients suggests that the causative agent may be a virus transmitted mainly by sexual contact. Recently, using techniques of genomic analysis, DNA sequences of a new herpes virus were identified in a majority of AIDS- as well as in some non AIDS-associated KS lesions. The virus designated KS-associated herpes virus (KSHV) or human herpes virus 8 (HHV-8) has also been detected in peripheral blood monocytes of KS patients, sometimes even preceding the appearance of KS lesions. The same KSHV has been identified in a very rare form of AIDS-associated lymphoma arising in body cavities, Non Hodgkin lymphomas (NUL) are the neoplasms most commonly associated with immune deficiencies of all types, congenital and acquired. They do not show the variations between various risk groups seen in KS. Their incidence in AIDS is constantly increasing in contrast to the present decline of KS. The development of NHL shows a latency of 4 to 6 years and a probability of affecting 28% of AIDS patients after 3 years of AZT treatment. The onset of NHL correlates with decreases of CD4+ T cells below 100 per nun3. The AIDS-related NHL exhibit clinical and histologic features that are different from those of NHL in the general population. Viral studies have shown the presence of EBY in AIDS-NEIL with variations between 36 to 100% according to histologic types. Involvement of the brain, only 1 % of all lymphomas in the general population is as common as 20% in AIDS patients. In cerebral NHL, both EBV and rearranged c-myc oncogene are present in 100% of AIDS versus only 30-40% of non AIDS patients. Anogenital neoplasms related to infection with human papilloma viruses (HPV), genotypes 16 and 18, are also far more common in AIDS patients. Tumors of smooth muscle, leiomyoma and leiomyosarcoma seen almost exclusively in adults have been recently reported in children with AIDS. Lung cancer in AIDS patients shows a greater incidence and a shorter survival and is associated with molecular changes reflecting widespread genomic instability.

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Paper presented at the International Symposium on the Impact of Biotechnology on Prediction, Prevention and Treatment of Cancer; Nice, France; October 24 - 27, 1998; in the section on Cofactors.

http://www.cancerprev.org/Journal/Issues/22/101/7/2529