1st August 2023

Malignancies Associated with HIV

The three cancers most closely associated with HIV are Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and cervical cancer –all of which are AIDS-defining illnesses. HIV patients are also at increased risk of liver and anal cancer and Hodgkin’s lymphoma.

Kaposi’s sarcoma

A type of skin tumour which originates from vascular and lymphatic endothelial skin layers. There is a strong aetiological association with herpesvirus type 8 (HHV-8).

It presents as characteristically purplish flat or nodular lesions. The form associated with HIV causes a severe presentation, with widespread lesions of the skin and oral cavity, as well as visceral disease in the bowel and lungs.

Skin and lymph node disease can be treated with localised radiotherapy, and systemic chemotherapy is given for disseminated disease. ART can also lead to the regression of lesions.

An example of limited Kaposi’s sarcoma, affecting the tip of a patient’s nose

Image Source: Wikimedia Commons (2018). Kaposi’sSarcoma, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Kaposi%27sSarcoma.jpg (Accessed: 12 July 2023).

Severe widespread cutaneous Kaposi’s sarcoma

Image Source: Wikimedia Commons (2008). Kaposi’s sarcoma before, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Kaposi%27s_sarcoma_before.jpg (Accessed: 12 July 2023).

Non-Hodgkin’s lymphoma

Large B-cell type lymphoma is the most common lymphoma in HIV patients. Epstein-Barr virus (EBV) is strongly implicated in aetiology in HIV patients.

Typically, lymphoma in HIV patients is very aggressive and frequently causes extranodal disease in the brain, lung, and gastrointestinal tract, with severe systemic ‘B’ symptoms (i.e. fatigue, weight loss, night sweats).

Treatment is with aggressive chemotherapy –there is a poor response rate, and the prognosis is poor for HIV-related lymphoma.

Cervical cancer

Women with HIV are at significantly increased risk of cervical cancer, especially caused by human papillomavirus (HPV). Colposcopy is offered to patients with a cervix at diagnosis, and annual smear tests are subsequently indicated.