HIV and Malignancies

The vast majority of HIV-infected individuals can now achieve and maintain undetectable viral load on antiretroviral therapy. However, HIV-infected individuals continue to be at higher risk for non-AIDS associated complications including malignancies which now account for the majority of deaths. Population-based epidemiologic studies have supported the finding that colorectal cancer (CRC) is significantly elevated in HIV-infected individuals compared to the general population.

Neurologic complications of HIV infection are common. Among the most devastating of these is primary CNS lymphoma, an AIDS-defining illness which is highly aggressive and usually associated with short survival. Establishing the pathologic basis of focal brain lesions in the setting of HIV infection can be difficult for a number of reasons, including the fact that results of neuro-imaging and DNA PCR evaluations are non-specific and cytological testing of cerebrospinal fluid is highly insensitive.

Neurologic complications of HIV infection are common. Among the most devastating of these is primary CNS lymphoma, an AIDS-defining illness which is highly aggressive and usually associated with short survival. Establishing the pathologic basis of focal brain lesions in the setting of HIV infection can be difficult for a number of reasons, including the fact that results of neuro-imaging and DNA PCR evaluations are non-specific and cytological testing of cerebrospinal fluid is highly insensitive.

In sub-Saharan Africa, the intersection between the HIV epidemic and the endemic nature of Kaposi's sarcoma-associated herpesvirus (KSHV) infection has resulted in Kaposi's sarcoma (KS) becoming the most common malignancy in many parts of the region. Now that highly active antiretroviral therapy (HAART) is becoming available in Africa, many patients with AIDS-related KS are receiving HAART alone as first-line therapy.

In sub-Saharan Africa, the intersection between the HIV epidemic and the endemic nature of Kaposi's sarcoma-associated herpesvirus (KSHV) infection has resulted in Kaposi's sarcoma (KS) becoming the most common malignancy in many parts of the region. Now that highly active antiretroviral therapy (HAART) is becoming available in Africa, many patients with AIDS-related KS are receiving HAART alone as first-line therapy.

Cervical cancer and HIV are intersecting epidemics that both disproportionately affect low-income women. The impact of the socioeconomic disparity and biologic synergy of these two diseases is seen most dramatically in sub-Saharan Africa, where cervical cancer is the most common cancer killer among women, and new HIV infections are five times more likely to occur in young women than men. HIV-infected women are at increased risk for the development of cervical precancer and cancer, develop more aggressive lesions and are affected at younger ages.

Cervical cancer and HIV are intersecting epidemics that both disproportionately affect low-income women. The impact of the socioeconomic disparity and biologic synergy of these two diseases is seen most dramatically in sub-Saharan Africa, where cervical cancer is the most common cancer killer among women, and new HIV infections are five times more likely to occur in young women than men. HIV-infected women are at increased risk for the development of cervical precancer and cancer, develop more aggressive lesions and are affected at younger ages.

Objective: Despite the availability of life-saving antiretroviral therapy (ART) in sub-Saharan Africa, our group and others have observed that a substantial proportion of individuals with Kaposi sarcoma (KS) initiate ART only after progressing to advanced-stage disease. While early-stage KS is likely to respond to ART alone, late-stage KS relies on chemotherapy and a sophisticated medical system capable of providing supportive care, neither of which are currently available in Uganda.

Objective: Despite the availability of life-saving antiretroviral therapy (ART) in sub-Saharan Africa, our group and others have observed that a substantial proportion of individuals with Kaposi sarcoma (KS) initiate ART only after progressing to advanced-stage disease. While early-stage KS is likely to respond to ART alone, late-stage KS relies on chemotherapy and a sophisticated medical system capable of providing supportive care, neither of which are currently available in Uganda.

The vast majority of HIV-infected individuals can now achieve and maintain undetectable viral load on antiretroviral therapy. However, HIV-infected individuals continue to be at higher risk for non-AIDS associated complications including malignancies which now account for the majority of deaths. Population-based epidemiologic studies have supported the finding that colorectal cancer (CRC) is significantly elevated in HIV-infected individuals compared to the general population.