Stephen Rathinaraj Corr

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Stephen Rathinaraj Corr

  1. 1. HIV and AIDS-related Cancer *1V. Rajamanickam, 2B. Stephen Rathinaraj, 3B. Rathna Daisy, 4G.S. Bangale, 2Md. Fareedullah, 2Farsiya Fatima, 2Fatima Shireen 1Arulmigu Kalasalingam College of Pharmacy, Krishnankoil, Tamilnadu, India. 2Vaagdevi College of Pharmacy, Hanamkonda, Warangal, Andhrapradesh, India. 3Annasamy College of Nursing, VeerakeralamPudur, Thirunelveli, Tamilnadu, India. 4Government College of Pharmacy, Amravati, Maharashtra, India.ABSTRACT INTRODUCTION Cancer remains a significant burden for human Acquired Immune Deficiency Syndrome (AIDS) isimmunodeficiency virus (HIV)-infected individuals. Most a disease of the immune system caused by infectioncancers that are associated with HIV infection are driven with the Human Immunodeficiency Virus (HIV). HIVby oncogenic viruses, such as Epstein–Barr virus, Kaposi’s is transmitted from person to person most commonlysarcoma-associated herpes virus and human papillomavirus. in blood and bodily secretions (such as semen). AGaining insight into the epidemiology and mechanisms that person with HIV is highly vulnerable to life-threateningunderlie AIDS-related cancers has provided us with a better conditions, because HIV severely weakens the body’sunderstanding of cancer immunity and viral oncogenesis. immune system. When HIV infection causes symptoms and specific disease syndromes, the disease is called AIDS. ABOUT HIV/AIDS-RelATeD CANCeR People with HIV/AIDS have a high risk of developing certain cancers, such as Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer. For people with HIV, these three cancers are often called “AIDS-definingKey Words: AIDS, Kaposi’s sarcoma cancer, cervical cancer, conditions,” meaning that if a person with an HIVNon-Hodgkin lymphoma. infection has one of these cancers it can signify theCorresponding Author: Dr. V. Rajamanickam, M.Pharm, Ph.D, Associate Professor, Department of Pharmaceutical Chemistry,A.K. College of Pharmacy, Krishnankoil, Tamilnadu, India.Phone No:+0091-9486321521, Email: steaje@gmail.com 75
  2. 2. Stephen Rathinarajdevelopment of AIDS. The connection between HIV/ CeRVICAl CANCeRAIDS and certain cancers is not completely understood,but the link likely depends on a weakened immune Cervical cancer starts in a woman’s cervix, the lower,system.1 Most types of cancer begin when normal cells narrow part of the uterus. The uterus holds the growingbegin to change and grow uncontrollably, forming a mass fetus during pregnancy. The cervix connects the lowercalled a tumor. A tumor can be benign (noncancerous) part of the uterus to the vagina and, with the vagina,or malignant (cancerous, meaning it can spread to other forms the birth canal. Cervical cancer is also called cancerparts of the body). The types of cancer most common of the cervix. Women with HIV/AIDS have a higher riskfor people with HIV/AIDS are described in more detail of developing cervical intraepithelial neoplasia (CIN), abelow. precancerous growth of cells in the cervix that may be associated with human papillomavirus (HPV) infection. High-grade CIN can turn into invasive cervical cancer.KAPOSI SARCOMA learn more about cervical cancer. Kaposi sarcoma is a type of skin cancer, whichhas traditionally occurred in older men of Jewish or OTHeR TyPeS OF CANCeRMediterranean descent, young men in Africa, or peoplewho have had organ transplantation. Today, Kaposi Other, less common types of cancer that maysarcoma is found most often in homosexual men with develop in people with HIV/AIDS are HodgkinHIV/AIDS and is related to an infection with the human lymphoma,angiosarcoma (a type of cancer that beginsherpes virus 8 (HHV-8). Kaposi sarcoma in people with in the lining of the blood vessels), anal cancer, liverHIV is often called epidemic Kaposi sarcoma. HIV/ cancer, mouth cancer, throat cancer, lung cancer, testicularAIDS-related Kaposi sarcoma causes lesions to arise cancer, colorectal cancer, and multiple types of cancerin more than one area of the body, including the skin, including basal cell carcinoma, squamous cell carcinoma,lymph nodes, and organs such as the liver, spleen, lungs, and melanoma.and digestive tract. Kaposi sarcoma is the most common HIV/AIDS-related cancer, and it is more common in men than women. It isNON-HODgKIN lyMPHOMA estimated that a person with an HIV infection is 20,000 times more likely to develop Kaposi sarcoma than a person Non-Hodgkin lymphoma (NHl) is a cancer of the without HIV. However, Kaposi sarcoma has decreasedlymph system. lymphoma begins when cells in the lymph due to improved HIV treatment. For people with Kaposisystem change and grow uncontrollably, which may form sarcoma, the three-year survival rate (the percentage ofa tumor. The lymph system is made up of thin tubes that people who survive at least three years after the cancerbranch to all parts of the body. Its job is to fight infection is detected, excluding those who die from other diseases)and disease. The lymph system carries lymph, a colorless for people in the good-risk category for T and S factorsfluid containing white blood cells called lymphocytes. (see Staging) is 90%. For people in the poor risk category,lymphocytes fight germs in the body. groups of tiny, the three-year survival rate is 50%.bean-shaped organs called lymph nodes are locatedthroughout the body at different sites in the lymph system. Cancer survival statistics should be interpretedlymph nodes are found in clusters in the abdomen, groin, with caution. These estimates are based on data frompelvis, underarms, and neck. Other parts of the lymph thousands of cases of each type of cancer in the Unitedsystem include the spleen, which makes lymphocytes and States each year, but the actual risk for a particularfilters blood; the thymus, an organ under the breastbone; individual may differ. It is not possible to tell a person howand the tonsils, located in the throat. There are many long he or she will live with HIV/AIDS-related cancer.different subtypes of NHl. The most common subtypes Because the survival statistics are measured in multi-yearof NHl in people with HIV/AIDS are primary central intervals, they may not represent advances made in thenervous system lymphoma (affecting the brain and spinal treatment or diagnosis of this cancer.2,3fluid), primary effusion lymphoma (causing fluid to buildup around the lungs or in the abdomen), or intermediate The risk factor is anything that increases a person’sand high-grade lymphoma. learn more about non- chance of developing cancer. Although risk factorsHodgkin lymphoma. can influence the development of cancer, most do not Austral - Asian Journal of Cancer ISSN-0972-2556, Vol. 10, No. 2, April 2011 pp 5-14 76
  3. 3. directly cause cancer. Some people with several riskfactors never develop cancer, while others with no knownrisk factors do. However, knowing your risk factors andcommunicating them to your doctor may help you makemore informed lifestyle and health care choices. Thefollowing factors may raise a person’s risk of developingan HIV/AIDS-related cancer. Human papillomavirus infection. Research indicates Austral - Asian Journal of Cancer ISSN-0972-2556, Vol. 10, No. 2, April 2011 77
  4. 4. Stephen Rathinarajfactors when choosing a diagnostic test: nodes and other organs. Most often, endemic Kaposi sarcoma causes skin lesions without any other symptoms• Age and medical condition that do not spread to other parts of the body.4• The type of cancer suspected• Severity of symptoms• Previous test results Acquired Kaposi sarcoma The following tests may be used to diagnose an HIV/ Acquired (or immuno-suppressive treatment-related orAIDS-related cancer or determine if or where it has transplant-related) Kaposi sarcoma develops in peoplespread: who have received an organ transplant and are taking drugs to suppress (lower) their immune system, so their Biopsy. A biopsy is the removal of a small amount of body will not reject a transplanted organ. Because of treat-tissue for examination under a microscope. Other tests ment to lower the immune system, secondary diseases orcan suggest that cancer is present, but only a biopsy can infections can occur. Kaposi sarcoma is 150 to 200 timesmake a definite diagnosis. The sample removed during more likely to develop in people who have received anthe biopsy is analyzed by a pathologist (a doctor who organ transplant than in the general population. Most ofspecializes in interpreting laboratory tests and evaluating the time, acquired Kaposi sarcoma only affects the skin,cells, tissues, and organs to diagnose disease). but the disease can spread to the mucous membranes or other organs. Computed tomography (CT or CAT) scan. A CT scancreates a three-dimensional picture of the inside of thebody with an x-ray machine. A computer then combines epidemic Kaposi sarcomathese images into a detailed, cross-sectional view thatshows any abnormalities or tumors. Sometimes, a contrast epidemic Kaposi sarcoma causes lesions to form inmedium (a special dye) is injected into a patient’s vein to many different areas on the body and may affect theprovide better detail. CT scans of the chest and abdomen lymph nodes and organs, such as the liver, spleen, lungs,can help find cancer that has spread to the lungs, lymph and in the digestive tract. Acquired immune deficiencynodes, or liver. syndrome (AIDS) is a disease of the immune system caused by infection with the human immunodeficiency virus (HIV). Today, Kaposi sarcoma is found most oftenKAPOSI SARCOMA in homosexual men with HIV/AIDS, and is often related There are several types of Kaposi sarcoma: to an infection with the human herpes virus 8 (HHV-8). Kaposi sarcoma in people with HIV/AIDS is often called epidemic Kaposi sarcoma. It is the most common type ofClassic Kaposi sarcoma Kaposi sarcoma. learn more about HIV/AIDS-related cancer. Classic Kaposi sarcoma traditionally occurs in older menof Jewish or Mediterranean descent. lesions most oftenappear on the lower body, particularly the legs, ankles, or STATISTICSsoles of the feet. Classic Kaposi sarcoma is more commonin men than women, and lesions may develop over a Kaposi sarcoma develops in less than 1% of the generalperiod of 10 to 15 years. population. About one in 200 transplant recipients in the United States develops the disease. Previously, approximately one in four homosexual men with HIV/endemic Kaposi sarcoma AIDS developed Kaposi sarcoma. This number has decreased over recent years because of more effective endemic (or African) Kaposi sarcoma usually develops treatments for HIV/AIDS.5in people living in equatorial Africa. Most often endemicKaposi sarcoma is the same as classic Kaposi sarcoma, The overall five-year relative survival rate (percentagebut people usually get the disease at a younger age. A of people who survive at least five years after the cancerparticularly aggressive form can develop in children who is detected, excluding those who die from other diseases)have not yet reached puberty, usually involving the lymph for Kaposi sarcoma is about 60%. The three-year Austral - Asian Journal of Cancer ISSN-0972-2556, Vol. 10, No. 2, April 2011 78
  5. 5. HIV and AIDS-related Cancerrelative survival rate for people in the good-risk category clinical trials organization in the world and is funded(see Staging) in both the T and S factors is 90%. People by the National Institutes of Health. The TIS systemin the poor-risk category in the T and S factors have a evaluates:three-year relative survival rate of 50%. • The size of the tumor (Tumor, T) Cancer survival statistics should be interpretedwith caution. These estimates are based on data from • The status of the immune system, which is measuredthousands of cases of this type of cancer, but the actual by the number of a certain type of white blood cell,risk for a particular individual may differ. Because the called a CD4 cell, in the blood (Immune System, I)survival statistics are measured in multi-year intervals,they may not represent advances made in the treatment • The spread of the disease or the presence of HIV/or diagnosis of this cancer. It is not possible to tell a person AIDS-related systemic illness (Systemic Illness, S)how long he or she will live with Kaposi sarcoma. learnmore about understanding statistics. Within each of the three parts of the system, there are two subgroups: good risk (0, zero) or poor risk (1, one). For epidemic Kaposi sarcoma, there is no officiallyaccepted staging system; however, in 1988 the AIDS The following table (no:1) has been adapted from theClinical Trials group (ACTg) developed a staging system original system, developed by the ACTg to illustrate thecalled the TIS system. The ACTg is the largest HIV TIS system.Table:1 Stages of AIDS related cancer Good Risk (0) Poor Risk (1) (Any of the following) (Any of the following) Tumor (T) Only located in the skin and/or lymph nodes and/or minimal Tumor-associated edema oral disease (flat lesions confined to the palate or roof of the (fluid buildup) or ulceration mouth) extensive oral (mouth) Kaposi’s sarcoma gastrointestinal Kaposi’s sarcoma Kaposi’s sarcoma in other organs in the body Immune system CD4 cell count is 200 or more cells per cubic millimeter CD4 cell count is less than (I) 200 cells per cubic mil- limeter Systemic illness No systemic illness present History of systemic illness (S) and/or thrush No “B” symptoms (Note: “B” symptoms are unexplained fever, One or more “B” symptoms night sweats, greater than 10% involuntary weight loss, or diar- are present rhea persisting more than 2 weeks.) A Karnofsky performance status score of 70 or higher (The A Karnofsky performance Karnofsky Performance Status scale measures the ability of people status of less than 70 with cancer to perform ordinary tasks. A score of at least 70 means that a person can take care of themselves, but is unable to carry on Other HIV-related illness is normal activity or active work.) present (for example, neuro- logical disease or lymphoma) Austral - Asian Journal of Cancer ISSN-0972-2556, Vol. 10, No. 2, April 2011 79
  6. 6. Stephen RathinarajKarnofsky Performance Score Function a sharp, spoon-shaped instrument. The area can then be treated with electrodesiccation, which uses electric100 Normal, no evidence of disease current to control bleeding and kill any remaining90 Able to perform normal activity with only minor cancer cells. Many patients have a flat, pale scar from symptoms this procedure.80 Normal activity with effort, some symptoms70 Able to care for self, but unable to do normal activities Cryosurgery60 Requires occasional assistance, cares for most needs Cryosurgery (also called cryotherapy or cryoablation)50 Requires considerable assistance uses liquid nitrogen to freeze and kill cells. The skin will40 Disabled, requires special assistance later blister and slough off (shed off). This procedure30 Severely disabled will sometimes leave a pale scar. More than one freezing20 Very sick, requires active supportive treatment may be needed.10 Moribund (dying; at the point of death)0 Dead Photodynamic therapyTReATMeNT In photodynamic therapy, a light-sensitive substance is injected into the lesion and stays longer in cancer cells The treatment of Kaposi sarcoma depends on the size than in normal cells. A laser is directed at the lesion toand location of the tumor, whether the cancer has spread, destroy the cancer cells.and the person’s overall health. In many cases, a team ofdoctors will work with the patient to determine the besttreatment plan. Radiation therapy This section outlines treatments that are the standard Radiation therapy uses high-energy x-rays or otherof care (the best treatments available) for this specific particles to kill cancer cells. A doctor who specializestype of cancer. Patients are also encouraged to consider in giving radiation therapy to treat cancer is called aclinical trials when making treatment plan decisions. A radiation oncologist. Treatment may cause a rash, dry orclinical trial is a research study to test a new treatment red skin, or it may change the color of the skin. Traditionalto prove it is safe, effective, and possibly better than external-beam radiation therapy delivers x-rays from astandard treatment. your doctor can help you review all machine outside the body to remove the tumor. It maytreatment options. For more information, see the Clinical also be given as a palliative treatment (care given toTrials section. improve quality of life by treating the symptoms and side effects of the cancer or its treatment). A radiation therapy Descriptions of the most common treatment options for regimen (schedule) usually consists of a specific numberKaposi sarcoma are listed below. of treatments given over a specific time.Surgery Chemotherapy The goal of surgery is to remove the lesion and the Chemotherapy is the use of drugs to kill cancersurrounding normal tissue (called a margin). Surgery is cells. Systemic chemotherapy is delivered through themost useful when the lesions are located in a single area bloodstream, targeting cancer cells throughout theor a few specific areas. Two types of surgical procedures body. Chemotherapy is given by a medical oncologist,used for Kaposi sarcoma are described below: a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor’s office or outpatient clinic; others mayCurettage and electro desiccation go to the hospital. A chemotherapy regimen usually consists of a specific number of cycles given over a In this procedure, the cancer is removed with a curette, specific time. Sometimes, chemotherapy is injected Austral - Asian Journal of Cancer ISSN-0972-2556, Vol. 10, No. 2, April 2011 80
  7. 7. HIV and AIDS-related Cancerdirectly into the lesion to kill the cancer cells, called Antiviral treatmentintralesional injections. Commonly used drugs forepidemic Kaposi sarcoma are liposomal doxorubicin Antiviral treatment for HIV/AIDS helps reduce a(Doxil, Dox-Sl, evacet, lipoDox), paclitaxel (Taxol), person’s likelihood of getting Kaposi sarcoma and canand vinorelebine (Navelbine, Alocrest). The side reduce the severity of Kaposi sarcoma. HAART helpseffects of chemotherapy depend on the individual and treat the tumor and reduce the symptoms associated withthe dose used, but can include nausea and vomiting, Kaposi sarcoma for people with HIV/AIDS. It is usuallyloss of appetite, diarrhea, fatigue, low blood count, used before other treatments, such as chemotherapy.bleeding or bruising after minor cuts or injuries,numbness and tingling in the hands or feet, headaches,hair loss, and darkening of the skin and fingernails. SurgeryThese side effects usually go away once treatment isfinished.6 The goal of surgery is to remove the lesion and the surrounding normal tissue (called a margin). Surgery may be performed by a surgical oncologist, a doctor whoImmunotherapy specializes in treating cancer using surgery. Surgery is most useful when the lesions are located in a single area or a Immunotherapy (also called biologic therapy) is few specific areas. Two types of surgical procedures useddesigned to boost the body’s natural defenses to fight for Kaposi sarcoma are described below.cancer. It uses materials either made by the body or ina laboratory to bolster, target, or restore immune system Curettage and electrodessication. In this procedure,function. Sometimes, Kaposi sarcoma responds well to the cancer is removed with a curette, a sharp, spoon-alpha-interferon, which appears to work by changing shaped instrument. The area can then be treated withproteins on the surface of the cancer cells and by electrodessication, which uses an electric current toslowing their growth. The most common side effects of control bleeding and kill any remaining cancer cells.immunotherapy are a decreased white blood cell count Many patients have a flat, pale scar from this procedure.and flu-like symptoms. Cryosurgery. Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells.Antiviral treatment The skin will later blister and slough off (shed off). This procedure will sometimes leave a pale scar. More than For patients with epidemic Kaposi sarcoma, antiviral one freezing may be needed.treatment for HIV/AIDS helps reduce a person’s riskof developing Kaposi sarcoma. Highly active antiviraltreatment (HAART) can help treat the tumor and NON-HODgKIN lyMPHOMAreduce the symptoms from epidemic Kaposi sarcoma.It is usually used before any other treatments, such as Blood tests. Many different blood tests providechemotherapy. information about the diagnosis of lymphoma, its effect on the body, and how the disease is responding to treatment.KAPOSI SARCOMA Bone marrow aspiration and biopsy. lymphoma often spreads to the bone marrow, the spongy material in the The treatment of HIV/AIDS-related Kaposi sarcoma center of bones where blood cells are produced. lookingusually cannot cure the cancer, but it can help relieve at a sample of the bone marrow can be important forpain or other symptoms. Doctors will often try to treat doctors to diagnose lymphoma and to determine if itthe HIV/AIDS itself with antiretroviral treatments; has spread.treatment against HIV with highly active antiretroviraltreatment (HAART) can effectively control the virus in The most common site to biopsy the bone marrow is themost patients. This can be followed by palliative care (care back of the pelvic (hip) bone. The skin is numbed, and agiven to improve quality of life by treating symptoms and needle is inserted into a bone in the hip until it reachesside effects of the cancer or its treatment) for Kaposi the marrow. A small amount of bone marrow is removedsarcoma. and examined under a microscope. Austral - Asian Journal of Cancer ISSN-0972-2556, Vol. 10, No. 2, April 2011 81
  8. 8. Stephen Rathinaraj Magnetic resonance imaging (MRI). An MRI uses clinical trial is a research study to test a new treatmentmagnetic fields, not x-rays, to produce detailed images of to prove it is safe, effective, and possibly better thanthe brain and spinal column. MRIs create more detailed standard treatment.7pictures of soft tissues and nerves than CT scans. Acontrast medium may be injected into a patient’s vein to It is often difficult to treat cancer in people with AIDScreate a clearer picture. because of the increased risk of infections due to decreased white blood cell count and immune function caused by Bone scan. A bone scan uses a radioactive tracer to HIV. However, doctors and researchers are always lookinglook at the inside of the bones. The tracer is injected for better ways to treat patients, and recent research hasinto a patient’s vein. It collects in areas of the bone and is resulted in medical advances. Descriptions of the mostdetected by a special camera. Healthy bone appears gray common treatments for HIV/AIDS-related cancers areto the camera, and areas of injury, such as those caused listed below, outlined by the specific type of cancer.by cancer, appear dark. Pap test. The doctor gently scrapes the outside of the Positron emission tomography (PeT) scan. A PeT scan cervix and vagina and takes samples of the cells for testing.is a way to create pictures of organs and tissues inside learn more about what to expect when having a pap test.the body. A small amount of a radioactive substance isinjected into a patient’s body. This substance is absorbed Colposcopy. The doctor may do a colposcopy to checkmainly by organs and tissues that use the most energy. the cervix for abnormal areas. A special instrument calledBecause cancer tends to use energy actively, it absorbs a colposcope (an instrument that magnifies the cells of themore of the radioactive substance. A scanner then detects cervix and vagina, similar to a microscope) is used. Thethis substance to produce images of the inside of the body. colposcope gives the doctor a lighted, magnified view ofThe exact accuracy and role of PeT scanning in NHl is the tissues of the vagina and the cervix. The colposcope isnot yet clear, although aggressive subtypes of lymphomas not inserted into the woman’s body, and the examinationoften show up on PeT scans. Many oncologists will is not painful, can be done in the doctor’s office, and hasrecommend a PeT scan as part of the initial evaluation, no side effects. It can even be done on pregnant women.especially for the aggressive lymphomas. In the future,a PeT scan may help doctors monitor the disease’s Treatment for women with the precancerous conditionresponse to treatment. There is also some evidence that called CIN (see Overview) are generally not as effectiveusing a PeT scan after one or two cycles of treatment for women with HIV/AIDS due to a weakened immunemay be a useful way to predict if that treatment is likely system. Often, the standard treatment for HIV/AIDSto completely get rid of the lymphoma. This is not yet can reduce the symptoms of CIN. Women with invasiveproven, but it is being evaluated in many research studies cervical cancer, and whose HIV/AIDS is well-controlledaround the world. by medication, are generally treated similarly to women who do not have HIV/AIDS. Common treatment options include surgery, radiation therapy, and chemotherapy.CeRVICAl CANCeR learn more about cervical cancer treatment. The staging of HIV/AIDS-related cervical cancer is thesame system used for women with cervical cancer who do Clinical Trials Resourcesnot have HIV. learn more about cervical cancer staging. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than aTreatment standard treatment. The clinical trial may be evaluating a new drug, a new combination of existing treatments, a The treatment of HIV/AIDS-related cancer depends new approach to radiation therapy or surgery, or a newon the type of cancer, the size and location of the tumor, method of treatment or prevention.whether the cancer has spread, and the person’s overallhealth. This section outlines treatments that are thestandard of care (the best treatments available) for these NON-HODgKIN lyMPHOMAtypes of cancer. Patients are also encouraged to considerclinical trials when making treatment plan decisions. A generally, people with HIV/AIDS-related non-Hodgkin Austral - Asian Journal of Cancer ISSN-0972-2556, Vol. 10, No. 2, April 2011 82
  9. 9. HIV and AIDS-related Cancerlymphoma have advanced disease at the time of diagnosis, system. However, with improving retroviral treatment,and doctors use a staging system called the Ann Arbor patients with HIV/AIDS-related non-Hodgkin lymphomasystem. This is the same system that is used for non- are usually treated with the same doses of drugs given toHodgkin lymphoma in people who do not have HIV/ people with lymphoma who do not have HIV.AIDS. The stage of lymphoma describes the extent of spread Targeted therapyof the tumor. There are four stages: stages I through IV(one through four). Targeted therapy is a treatment that targets specific genes, proteins, or the tissue environment that contributesStage I: either one of these conditions: to cancer growth and survival. Rituximab (Rituxan) is a type of targeted therapy called a monoclonal antibody• The cancer is found in one lymph node region (substance made in a laboratory that acts like the (stage I). antibodies the body naturally produces as part of the• The cancer has invaded one extra lymphatic organ immune system’s response to fight disease). Specifically, (organ outside of the lymph node system) or site rituximab targets B lymphocytes and is used in combination (identified using the letter “e”), but not any lymph with chemotherapy for most patients. node regions (stage Ie).Stage II: either one of these conditions: Radiation therapy• The cancer is in two or more lymph node regions on For people with HIV/AIDS-related lymphoma, radiation the same side of the diaphragm (stage II). therapy may be given along with chemotherapy.• The cancer involves a single organ and its regional lymph nodes (lymph nodes near the site of the cancer), with or without cancer in other lymph node CONClUSION regions on the same side of the diaphragm (stage IIe). Cancers can be very serious for HIV positive people.Stage III: Any of these conditions: On-going medical care allows for early diagnosis and treatment, or even prevention, in the case of cervical• There is cancer in lymph node areas on both sides of and anal cancers. the diaphragm (stage III).• There is involvement of an organ in the localized area (stage IIIe); involvement of the spleen, using the ReFeReNCe letter “S” (stage IIIS); or both (stage IIIeS). 1. Non–AIDS-Defining Malignancies in HIV. Top HIV Med. 2008;16(4):117-121Stage IV: lymphoma is called stage IV if there is a tumor 2. Cheung MC, Pantanowitz l, Dezube BJ. AIDS-Relatedin an organ outside of the lymph node system (called Malignancies: emerging Challenges in the era of Highly Activedisseminated involvement). Common sites are the liver, Antiretroviral Therapy. The Oncologist 2005;10:412–426 3. Sullivan RJ, Pantanowitz l, Casper C, Stebbing J, and Dezube BJ.bone marrow, or lungs. epidemiology, pathophysiology and treatment of Kaposi sarcoma- associated herpesvirus disease: Kaposi sarcoma, primary effusion lymphoma, and multicentric Castleman disease. Clin Infect Dis.MAIN TReATMeNT 2008 November 1; 47(9): 1209–1215 4. Pantanowitz l, and Dezube BJ. evolving Spectrum and Incidence of Non-AIDS-Defining Malignancies. Curr Opin HIV AIDS. 2009Chemotherapy January ; 4(1): 27-34 5. engels eA. Non-AIDS-defining malignancies in HIV-infected persons: etiologic puzzles, epidemiologic perils, prevention opportunities. AIDS. 2009 May 15; 23(8): 875–885. Chemotherapy is the primary treatment for non-Hodgkin 6. Chin-Hong, P & Palefsky, J.M. (2002). Natural history and clinical .V.lymphoma. Chemotherapy may be given by mouth or management of anal human papillomavirus disease in men andinjected into a vein. Previously, chemotherapy treatment women infected with human immunodeficiency virus. Clinicalfor HIV/AIDS-related non-Hodgkin lymphoma was given Infectious Diseases, 35. 1127-1134. 7. Scadden D.T. (2003). AIDS-related malignancies. Annual Reviewat lower doses because of the person’s weakened immune of Medicine 54:285. Austral - Asian Journal of Cancer ISSN-0972-2556, Vol. 10, No. 2, April 2011 83

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