AIDS and associated malignancies

(整期优先)网络出版时间:2005-11-21
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AIDSassociatedmalignancies(ARL)isamajorcomplicationassociatedwithAIDSpatientsuponimmunosuppression.Chronicallyimmunocompromisedpatientshaveamarkedlyincreasedriskofdevelopinglymphoproliferativedisease.Intheeraofpotentantiretroviralstherapy(ARV),themalignantcomplicationsduetoHIV-1infectionhavedecreasedindevelopednationswhereARVisadministered,butstillposesamajorproblemindevelopingcountrieswhereHIV-1incidenceishighandARVisstillnotyetwidelyavailable.EveninARVtreatedinpidualsthereisaconcernthattheprolongedsurvivalofmanyHIV-1carriersislikelytoeventuallyresultinanincreasednumberofmalignanciesdiagnosed.MalignanciesthatwerefoundtohavehighincidenceinHIV-infectedinpidualsareKaposi'ssarcoma(KS),Hodgkin'sdisease(HD)andnon-Hodgkin'slymphoma(NHL).TheincidenceofNHLhasincreasednearly200foldinHIV-positivepatients,andaccountsforagreaterpercentageofAIDSdefiningillnessintheUSandEuropesincetheadventofHAARTtherapy.TheseAIDSrelatedlymphomasaredistinctfromtheircounterpartsseeninHIV-1seronegativepatients.ForexamplenearlyhalfofallcasesofARLareassociatedwiththepresenceofagammaherpesvirus,EpsteinBarrvirus(EBV)orhumanherpesvirus-8(HHV-8)/Kaposi'ssarcomaassociatedherpesvirus(KSHV).ThepathogenesisofARLsiscomplex.B-cellproliferationdrivenbychronicantigenemiaresultingintheinductionofpolyclonalandultimatelymonoclonallymphoproliferationmayoccurinthesettingofsevereimmunosuppression.