HIV-Associated Cancers and Related Diseases

Abstract

Clusters of cases of pneumocystis pneumonia and Kaposi’s sarcoma in New York and California in men who had sex with men were early harbingers of the acquired immunodeficiency syndrome (AIDS) epidemic. The syndrome was also soon noted to be associated with a high incidence of aggressive B-cell lymphomas. As the AIDS definition crystallized, Kaposi’s sarcoma, aggressive B-cell lymphomas, and invasive cervical cancer were considered to be AIDS-defining cancers when they developed in patients with human immunodeficiency virus (HIV) infection. Additional cancers are now known to be associated with HIV (Table 1). The term HIV-associated cancer is used here to describe this larger group of cancers (both AIDS-defining and non–AIDS-defining cancers) that have an increased incidence among patients with HIV infection. In addition, incidental cancers also may develop in patients with HIV infection.

Figure 1.. Trends in AIDS and in Cancers among Persons with AIDS.

Panel A shows the AIDS population in the United States according to year and age group. Data are from the National HIV Surveillance System, Centers for Disease Control and Prevention. Panel B shows estimated numbers of cancers among people living with AIDS in the United States according to year, stratified according to AIDS-defining cancers, non–AIDS-defining cancers, and poorly specified cancers.

Figure 2.. Selected Clinical Manifestations of Kaposi’s Sarcoma.

In Panel A, advanced Kaposi’s sarcoma with tumor-associated edema and ulceration are shown on the thigh of a patient with Kaposi’s sarcoma–associated herpesvirus (KSHV) inflammatory cytokine syndrome (KICS). In Panel B, the CT scan shows diffuse, infiltrative pulmonary Kaposi’s sarcoma. In Panel C, Kaposi’s sarcoma of both legs and both feet, with associated “woody” edema, is shown in a patient with well-controlled HIV infection and a preserved CD4+ count. Panel D shows Kaposi’s sarcoma of the oral cavity, and Panel E shows characteristic Kaposi’s sarcoma lesions on the skin of the back.

Figure 3.. Pathological and Imaging Findings in KSHV-Associated Multicentric Castleman’s Disease and Primary Effusion Lymphoma.

In KSHV-associated multicentric Castleman’s disease (Panel A, hematoxylin and eosin), the involved lymph nodes often have regressed germinal centers surrounded by layered mantle cells, vascular proliferation and hyalinization, and interfollicular plasmacytosis. KSHV-encoded latency-associated nuclear antigen 1 (LANA-1) staining highlights KSHV-infected plasmablasts (Panel B). In a patient with KSHV multicentric Castleman’s disease (Panel C), F-fluorodeoxyglucose (FDG) positron-emission tomography shows symmetric FDG-avid lymph nodes noted in cervical, axillary, and inguinal chains; increased uptake of FDG is also noted in the enlarged spleen. In primary effusion lymphoma (Panel D), staining with modified rapid Wright–Giemsa (Diff-Quik) reveals large malignant lymphoid cells with basophilic cytoplasm and prominent nucleoli. LANA-1 staining (Panel E) highlights KSHV-infected lymphoma cells. In a case of primary effusion lymphoma (Panel F), a CT scan reveals pleural effusions. The pathological images are from Stefania Pittaluga and Hao-Wei Wang, Laboratory of Pathology, National Cancer Institute.