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n CME : Your SA Journal of CPD - HIV-associated malignancies : main article
The AIDS-defining malignancies are Kaposi's sarcoma, aggressive B-cell lymphoma, primary CNS lymphoma and cervix carcinoma.
Non-AIDS-defining malignancies like Hodgkin's lymphoma and anal carcinoma occur more frequently in the HIV-positive population but are not necessarily related to the level of immune suppression.
Kaposi's sarcoma is a vascular tumour caused by human herpesvirus 8 and occurs mainly in the skin and mucous membranes but can involve any organ.
Management of Kaposi's sarcoma starts with HAART and, if clinically indicated, either local therapy like radiotherapy or systemic chemotherapy.
AIDS-related lymphomas present at an advanced stage, are usually associated with B-symptoms and extranodal disease, and often involve unusual sites.
The commonest histologies are diffuse large B-cell and Burkitts's lymphoma. Those seen almost exclusively in HIV are plasmablastic and primary effusion lymphoma.
Primary CNS lymphoma in HIV is associated with a CD4 count < 50, EBV in the tumour and CSF, and a very poor prognosis.
Cancer in HIV-infected individuals is usually associated with a viral cause, e.g. HPV in cervix and anal carcinoma and EBV and HHV8 in ARLs.
Patients with unusual and aggressive cancers should be tested for HIV.
With HAART the incidence of AIDS-defining malignancies has decreased but non-AIDS-defining malignancies are increasing as HIV has become a chronic disease.
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