Other Malignancies

The incidence of Hodgkin's disease has been estimated to be up to 18-fold greater in HIV-infected individuals compared to the HIV-seronegative population. In patients with HIV infection and Hodgkin's disease, the clinical presentation usually includes B-symptoms (fever, night sweats, anorexia, and weight loss), stage III or IV disease, and extranodular disease. The histopathology is often the mixed cellularity or lymphocyte-depleted types. Furthermore, HIV-infected individuals with Hodgkin's disease appear to tolerate chemotherapy less well and may have a higher incidence of tumor relapse than do those without HIV infection.

Hodgkin's disease therapy among HIV-infected patients should be according to guidelines for non-HIV-positive individuals. The major difference is to incorporate prophylaxis against opportunistic infections, particularly P. carinii pneumonia, to be particularly alert to infectious complications during therapy, and to integrate growth factor support given the frequent cytopenias in HIV-infected hosts. We generally continue antiretroviral therapy, but drug interactions are possible and poorly defined at present.

Anal cancer and, to a lesser extent, cervical cancer occur with a higher incidence in HIV-infected patients. This is due to the high prevalence of papillomavirus infection in groups at risk for HIV and the dysplasia associated with it.

Frequent careful cervical examinations including colposcopy are indicated in HIV-infected women to detect early malignant change. Ongoing surveillance programs of HIV-infected individuals using Papanicolaou smears on cells from the transitional zone of the anus and cervix should provide important data as to the increased incidence and optimal surveillance programs for these cancers in this population. Invasive cancer of the uterine cervix has recently been added as an AIDS-defining illness in women infected with HIV.

Although anecdotal reports abound of other malignancies in HIV-infected individuals, it is unclear whether these occur above that of the background prevalence in the general population. Nonetheless, consideration should be given to the significance of the HIV infection in clinical management. These patients have a propensity to develop opportunistic infections when starting chemotherapy or radiation therapy and, in general, have fared poorly because of these infectious complications.