AIDS: A radiation oncologist′s perspective

Abstract

While HIV is often associated with tuberculosis and a number of opportunistic infections, the spectrum of diseases of patients with HIV infection encompasses a number of malignancies as well. Typically, these are the AIDS-defining malignancies, though other malignancies also comprise a significant caseload. Radiotherapy plays an integral part in anti-cancer treatment and its tolerance and efficacy in HIV+ patients are therefore important. The patient's level of immunity as manifested by the CD4 count has a significant bearing on treatment outcomes. In some cases, like primary central nervous system lymphoma (PCNSL), the occurrence of the malignancy itself is tied to the patient's immunity with increased incidence in patients with CD4 counts less than 50/mm 3. The success of highly active antiretroviral therapy (HAART) has allowed administration of standard doses of radiotherapy and even chemotherapy in recent times leading to improved outcomes. In general, standard radiotherapy and concomitant chemo-radiotherapy protocols should be used wherever possible, so as not to compromise disease control. Local control and disease-specific survival rates in HIV patients are no worse than in HIV? patients, but this is only true for CD4 counts above 200/mm 3. In certain situations like cervical intraepithelial neoplasia CIN, HAART itself is associated with disease regression. The question of increased radiosensitivity in HIV patients remains unresolved in most diseases and there are sparse data with regard to non-HIV associated malignancies in these patients. Greater caution and emphasis on good supportive care and HAART would appear to be essential when treating the malignancies in HIV+ patients with standard anti-cancer regimens.

The effect of HIV infection on the surgical, chemo- and radiotherapy management of breast cancer. A prospective cohort study

“…[30] This idea has however been disputed. [31] Epithelial toxicities have especially been reported in the treatment of AIDS-defining malignancies. Although the literature is scanty, radiotherapy seems to be well-tolerated by HIV infected patients with breast cancer.…”

Tumorigenesis related to retroviral infections

“…The most common HIV-associated cancers include Kaposi's sarcoma, which is a mesenchymal tumor originating from lymphatic endothelial cells; non-Hodgkin's lymphoma; and cervical cancer. Both HIV-1 and HIV-2 have been associated with an increased risk of cervical cancer [42]; moreover, Burkitt lymphoma is a highly aggressive tumor that contains one of the cancer subtypes highly affecting HIV-infected patients [40,43]. Current studies suggest that lung cancer risk is higher in HIV-infected patients than in uninfected persons [44,45].…”

“…It is important to note that although Hodgkin's lymphoma has been repeatedly associated with AIDS, the Centers of Disease Control and Prevention (CDC) do not consider it as an AIDSdefining illness [42,46]. All AIDS-associating diseases, including cancers, occur at exceptionally high incidence [39,42].…”

HIV Infection: Implications on Surgical Practice

“…The primary concern in AIDS patients on radiotherapy is the possibility of enhanced radiation toxicity due to inherent radiosensitivity and glutathione deficiency in AIDS patients (Mallik et al, 2010). Combination chemoradiation has registered significant success in the treatment of anal cancer, especially in the HAART era, with better outcomes for patients with CD4 counts above 200 cells/μL than for those with lower counts.…”

“…Combination chemoradiation has registered significant success in the treatment of anal cancer, especially in the HAART era, with better outcomes for patients with CD4 counts above 200 cells/μL than for those with lower counts. Toxicity from the intense chemoradiotherapy is the primary concern (Mallik et al, 2010;Oehler-Janne et al, 2006). To date, there has been no evidence that chemoradiation besides toxicity, causes progression of the tumor or AIDS, and ought to therefore be considered as a viable therapy for HIV/AIDS patients, especially those with CD4 counts above 200 cells/μL.…”