Malignancy in HIV/AIDs: A single hospital experience

Abstract

Background and Objectives: Our hospital serves an area with a significant number of patients seropositive for the human immunodeficiency virus (HIV). Intravenous drug abuse and heterosexual exposure are by far the predominant risk factors for HIV and acquired immunodeficiency syndrome (AIDS). Seven percent of these patients develop malignancies. Our aim was to study the types of tumor, their distribution, and to evaluate the patients' outcome. Methods: Of 3,578 patients with HIV infection or AIDS treated between 1993 and 1998, 245 had 1 or more malignancies. Information was collected on age, sex, race, predisposing risk factors for AIDS, malignancies, symptoms at presentation, the time of the onset of AIDS, CD4 cell counts, pathology findings, and mortality. Results: Although aspects of our patients resembled those of previously studied groups of patients with AIDS, there also were ways in which our patients differed from those other groups. Of our patients, 21.6% had non-AIDS-defining (NAD) invasive malignancies. This was considerably higher than the rate in most studies. Twenty-seven patients with such malignancies died during the study. Forty-two other patients had preinvasive cancers. Among patients having AIDS-defining (AD) malignancies, 55.9% died, a fact that was related to patients' low CD4 cell counts and late presentation. Our 97 patients with Kaposi sarcoma included 22 women, a relatively high number that may be related to the fact that most of our patients were intravenous drug abusers or had become infected by heterosexual transmission of HIV. Conclusions: AIDS is associated with a high risk of malignancy and an unusual spectrum of tumors. Patients with invasive tumors have advanced disease at the time of initial presentation. Those with AD tumors have a worse prognosis than patients with NAD tumors. The impact of highly active antiretroviral therapy on both AD and NAD tumors needs to be further evaluated.

Ten years later: A single hospital experience with malignancy in HIV/AIDS

“…We reviewed these patients' initial and readmission charts to collect information about age, sex, race, presenting symptoms and evolution, modalities used that lead to diagnosis, histology and anatomical location of tumor, and their stage at presentation according to the American Joint Committee on Cancer (AJCC), classification of tumors by CDC category, co‐morbidity, treatment for HIV and cancer, level of CD4 counts, duration of infection, dates of biopsies, present status of the patients and analysis of mortality. The results were electronically tabulated and the data base compared with the findings of our study done 10 years earlier when out of 3,578 HIV/AIDS patients 245 (7%) had malignancies 1.…”

“…In 2000 this journal published our article summarizing experience at our single community‐based, university‐affiliated hospital with 3,578 HIV/AIDS patients, of whom 245 had associated malignancies 1. That study was done in the Pre‐HAART era (from 1993 up to 1996) and extended to the initial stages of the use of HAART (1996–1998).…”

“…Our first retrospective study of malignancies in HIV/AIDS was based on the idea that a focused experience limited to a community‐based hospital with a significant number of HIV/AIDS patients, would best reflect the clinical reality and give a clear understanding of the progression of the disease to cancer 1. The present study was undertaken for purpose of comparison as a means of assessing progress and guiding ongoing efforts.…”

Cancers among HIV Infected Patients: A Reason for Routine Screening

“…(15) There is also a direct increase in Morbidity and Mortality due to delay in seeking treatment for cancer in the general population as well as among the HIV infected patients. (16) Cancer screening is a proven effective method of cancer prevention and control in many populations. (17) The Nigerian HIV treatment guide line includes AIDS defining malignancies as a criteria for staging but cancer screening is absent.…”