Cancer

“Among 86 322 patients included in the analysis, 132 had a diagnosis of anal cancer…102 occurred in the recent cART [combination Anti-Retroviral Therapy] period (1999– 2004)…The median CD4 cell count at anal cancer diagnosis increased with time from 188 cells/µl in the precART period to 288 cells/µl in the recent cART period. Nearly one-quarter of the patients had not received cART before the onset of anal cancer [i.e. more than three-quarters had received AIDS drugs]…In the precART, the early cART and the three sub-periods of the recent cART era (1999–2000, 2000–2001 and 2002–2003), the incidences of anal cancer were 10.5, 18.4, 43.1, 36.3 and 39.3 per 100 000 person-years, respectively.”

“Dramatic declines in KS [Kaposis Sarcoma] and NHL [Non-Hodgkins Lymphoma] were temporally related to improving therapies, especially introduction of HAART, but those with AIDS remain at marked risk. Among non-AIDS-related cancers, a recent increase in Hodgkin lymphoma was observed…Risk of Hodgkin Lymphoma increased substantially over the 1990-2002 period [8.1 times higher than the general population in 1990-5 and 13.6 times higher in 1996-2002]…[Table 2 shows that the risk of all non-AIDS associated cancers was double (compared to the general population) in 1980-9, 1.8 times higher in 1990-5 and 1.7 times higher in 1996-2002. Why would the risk of non-AIDS cancers be higher?]”

“With the advent of HAART there has been a dramatic decline in the incidence of Kaposi's Sarcoma [this may be a false association as many other things have changed, including usage patterns of nitrite inhalants]. However, the existence of B cell related lymphomas has not declined to the same extent…Bonnet et al noted that malignancies were the cause of death in 28% of HIV infected patients who died in 2000. Of 964 deaths, solid cancers accounted for 103 cases and included 50 lung, 19 hepatocellular [liver], 9 digestive and 6 anal cancers. The authors also reported 17 non-HIV-related hematological [blood] cancers.”

“We describe a patient who developed BL [Buschke-Loewenstein] tumour transformation of a long-standing perianal wart after sustained virological and immunological control of this chronic HIV infection [long-term use of AIDS drugs resulting in low 'viral load' and higher CD4 cell counts]…the perianal mass was now 15x10 cm [~6x4 inches] and was eroding both buttocks…A palliative colostomy was formed…He developed bacterial superinfection of the lesion and died 6 weeks later.”

“In HAART era, incidence rates of Kaposi’s sarcoma and cervical cancer have decreased, but NHL [non-Hodgkins lymphoma] remains the same. Incidence rates of five non-AIDS cancers (lung, head/neck, Hodgkin’s, anorectal, melanoma) in HIV-infected persons are significantly higher than in the general population…Recommendations: Smoking cessation counseling; Surveillance of cancers in HIV-infected persons with risk factor data. [stopping HAART was not on the list]”

“The five non-AIDS-defining cancers were lung, head/neck, Hodgkins disease, anorectal, [and] melanoma. Among the HOPS cohort…incidence of [these] four cancers was significantly greater than expected compared with the general popuation: lung (Relative Risk = 2.13), Hodgkins disease (RR = 4.58), anorectal (RR = 10.13), and melanoma (RR = 2.99). Among Chicago clinic patients, all five cancers were significantly increased in the multivariate analysis: lung (RR = 3.63), Hodgkins disease (RR = 77.43), anorectal (RR = 5.03), melanoma (RR = 4.10), head/neck (RR = 9.96)”

“As HIV-infected men experience longer lives in the era of highly active antiretroviral therapy (HAART), a higher incidence of prostate cancer may become more apparent [or HIV drugs could be causing prostate cancer]. Three cases of prostate cancer were identified in the past 18 months among 155 HIV-infected men over the age of 40 years in our clinic…our data suggest that it exceeds the annual national rate of 50–100 cases of prostate cancer per 100 000 persons. [All three patients were taking 3 or 4 AIDS drugs]”

“[from a news report on this article] During 2 years of follow-up, 51% of those undergoing HAART developed AIN-3 [anal intraepithelial neoplasia (cancer)] compared with 31% of those not receiving HAART. Thus, the prevalence and incidence of AIN-3 were clearly higher in men who received HAART, even after correction for baseline immune function, and the use of HAART did not reduce the incidence of AIN-3 during follow-up.”

“Among 71 HAART-treated women the prevalence of CIN [cervical intraepithelial neoplasia] before HAART was 55%. After a median of 10 months after starting HAART the prevalence had increased to 62% (P 0.20)”

“To our knowledge . . . cases of lymphoma that appear during the first weeks of therapy have not been published, although this possibility has been mentioned mainly in meetings. We report here three patients who developed rapidly growing lymphomas of different cell lineages within the first 2 months of the initiation of HAART . . . Several arguments strongly suggest that the relationship between the flare up of the lymphomas and HAART initiation is not casual. First, there is a strict temporal relationship between them. Second, the subsequent control of HIV replication and immune recovery induced by therapy should have mitigated, rather than accelerated, the appearance of the lymphoma. Third, bouts of another malignancy, Kaposi's sarcoma, which have been related to immune recovery after similar periods of HAART, have been reported. Fourth, the clinical presentation of the lymphomas in the three patients was remarkably abrupt, with the appearance of large, rapidly growing lymphomatous masses, despite the fact that both the clinical and radiological evaluation of these patients a few weeks earlier had failed to detect any manifestation of the malignancy. Fifth, although their observations have not been published, several authors have also suspected a relationship between the onset of HAART and the appearance of lymphomas in some patients. Finally, the incidence of lymphoma arising shortly after the onset of HAART seems to be higher than expected. In a study on a large cohort of patients that evaluated the development of opportunistic illnesses after the initiation of HAART, lymphomas were diagnosed within the first 3 months of treatment in three out of 14 patients (21%). The data from our institution are still more significant: 3 of the 5 patients in whom lymphoma was diagnosed while receiving HAART developed the malignancy within the first 2 months of therapy, a rate considerably higher than expected for such a short period.”

“We used a triple combination regimen, including nevirapine, for prophylaxis after occupational or sexual exposure to HIV-1 infection. Of 57 individuals who started therapy, only 41 returned for follow-up. Five had a grade three or four drug-induced hepatitis, two of whom also had a rash. This high rate of major adverse events raises concerns over the safety of such a regimen for its use in this population.”