HIV related cancer

lung cancer

-3rd most common malignany in patients w hiv -highest incidence of mortality among hiv related cancer average life expencetancy -67 month after diagnosis -possible link to chronic pulmonary inflammation and infection unclear -significant hematologic toxicity in most pt. receiving concomitant cART

HIV malignancy risk

-cancer is the most common cause of death among hiv infected individuals -women are at inc risk for cervical dysplasia that rapidly progresses to cervical cancer - average onset of malignancies has inc by 9 yrs due to cART therapy

HIV lymphoma met and presentation

-common affected site dt extranodal involvement GI tract, CNS, and bone marrow -primary effusion lymphoma is associated w HHV-8, multifocal lesions are common, BCL6 mutation is common -metastasis - CNS, GI tract, and BM -CNS lymphoma s associated with HIV and EBV, linked to lower CD4+ count

RISk for PCNSL

CD4 <100, often less than 50. uniformly associateed w EBV

HIV related lymphoma

CD4 <200, lack of CD20+ marker, lack of cART related lymphoma EBV is present in 33-67% of HIV lymphomas those w/o EBV have other genetic abnormalities BCL6 and C-myc rearrangement and p53 mutations Tat protein is r/t burkitt lymphomas

staging

CDC system Walter Reed staging system

diagnostic

Enzyme link immunosorbent assay ELISA; high sensitivity and specificity if ELISa is positive, test is repeated, if second test is positive, confirmatory western blot conducted on teh same specimen polymerase chain reaction or viral culture diagnosis of hiv related lymphoma - brain biospy got PCNSL, night sweats may be r/t myobacterium avium intracelulare and CNS symptoms are r/t cerebral toxoplasmosis

HIV

HIV 1 is more virulent compare to HIV 2 takes about 2-3 yrs to turn to AIDS average life expectancy is 11-14 yrs

AIDS defining malignancies

Kaposi sarcoma, Burkitt Lymphoma (EBV), NHL, cervical carcinoma B cell lymphoma is the most frequently diagnosed Kaposi Sarcoma has decreased dt antiretroviral therapy

medication that adverse interactions with antiretroviral agents

amiodarone anticonvulsants antihyperlipidemics antimicrobials (flagyl, rifabutin, rifampin) azole antifungals benzodiazepines contraceptives dexamethasone digitalis derivatives histamine 2 receptor agonists PPI warfarin

patho

apoptosis and reduced quantity of CD4 lymphocytes T4 lymphocytes dysfunction

body fluids

blood, and excretion w blood in it. cerebrospinal fluid, semen, vaginal fluids, synovial fluid, ambiotic fluid, pericadrial flui, pleural, and peritoneal fluid

transmission

body fluids including blood, semen, vaginal secretions, and breast milk surface antigen gp120 attracted to hose CD4 surface marker

IRIS severe immune reconstitution syndrome

brisk inflammatory response when the WBC rapidly increases most often occurs w initial cART therapy, toxoplasmosis, pneumocystitis, other opportunistic infection most often reported w lymphoma compare w other cancer, has been linked to rituximab

KS treatment

cART if not responsive then chemo: single: doxorubicin or paclitaxel combination chemo: vincristine, doxorubicin, bleomycin mTOR inhibition - redued tumor angiogenesis andleads to tumor regression radiotherapy - proton radiotherapy or superficial electro beam 10-30 Gy by 45 to 70 kV x-ray or 4-MV photon

non AIDs defning malignancies

cancers of the anus, head and neck, kidney, liver, lung, and NHL possible association w acute myelogenous leukemia colon, esophageal, and gastric cancers, melanoma, squamous cell skin cancer associated w viral infection: hepatitis b and c, hepatocellular cancer, EBV, hodgkin disease.

chemo for lymphomas

cyclophosphamide vincristine methotrexate etoposide cytosine arabinoside bleomycin steroids or methotrexate, bleomycin, doxorubicin, cyclophosphomide, vincristine, and decadron

PCNSL chemo

high dose methotrexate >3g/m2 high dose cytarabine >2g/m2 rituximab IT for lymphomatous meningitis, not useful in bulky disease

anal cancer

more common among men who practice anal intercourse associated w HIV w HPV no regression w cART combined chemo and radiation

hepatocellular carcinoma

more common w hepatitis B and HIV then w hep B and HIV more likely in HIV 1 inc rish w age and hepatic cirrhosis shorter life expentact responsive to sorafenib

hodkin disease

most common non AIDS defining malignancy -often occurs within 1 yr of diagnosis and cART intitation -pathology: mixed cellularity and lymphocyte depleted subtypes -more aggressive and less responsive than non HIV hodgkin disease (late stage presentation, common for multiple node gorups, less sensitive to chemo or radiotherapy)

radiotherapy for lymphoma

palliative or consolidation used to attempt to control

KS metastatic

presentation: skin lestions, ranging from pink to purple to brown, flat or raised, usually painless. do not blanch w pressure. lower extremities or face, oral cavity, and palate, GI tract, respiratory tract

HIV related kaposi sarcoma

soft tissue malignancy characterized by alignant growth of reticuloendothelial cell origin in hiv infecter persons HHV -8 aka as KS herpesvirus KPHV

Cervical cancer

squamous cell cancer colposcopy if lesions persist on cART cryotherapy for persistent lesions radiation therapy in form of brachytherapy

lyphoma prognosis for HIV related

survival depends on cART, degree of immunosuppression, presence of opportunistic infections, nutritional status, presenting lesion location, lifestyle, and accessibility of adequate care shorter survival assosciated w CD4 <1000. stage 3 or4 disease. >35 yo. history of IV drug use and elevated LDH median survival time is 4-10 months shrotest is 1-2 months longest survival w low gradelymphomas is 1-4 yrs

body fluid not associated

urine, feces, vomitus, perspiration, nasal secretion, tears, sputum or saliva (except in dental practice)

use of concomitant cART plus chemotherapy to be used cautiously when giving chemo with what?

zidovudine (AZT) dt bone marrow compromise