Molecular Basis for Therapy of AIDS-Defining Cancers

Cancer incidences increase in people living with HIV/AIDS. Over 2 million people currently live with HIV/AIDS in the US. This number will increase as HAART prolongs the average lifespan and as (at least in some states) the number of new HIV infections increase again. As this population ages their incidence rates for cancer will increase, as well.

Recently, new rational targets for cancer therapy have emerged. But their application to the care of HIV+ patients is slow, because of concerns about the weakened immune status of the patients, because of possible drug interactions with HAART and because some of the AIDS defining cancer are rare.

An increased risk for various cancers is a characteristic of people living with HIV infection.  Although only three cancers – Kaposi’s sarcoma, high-grade B-cell lymphomas, and invasive cervical cancer – are considered to be "AIDS-defining" conditions, are associated with oncogenic viruses, and occur with increased frequency as immune function declines, other cancer types also occur significantly more frequently in HIV-positive individuals than in the general population, but are not directly associated with clinical progression to AIDS. Notably these "non-AIDS-defining" cancers include virus-associated cancers such as anal cancer, hepatocellular cancer and Hodgkin’s disease, as well as non-virus associated cancers such as lung cancer. Importantly, there are also large worldwide differences in the incidence and behavior of different AIDS-associated cancers.

Although effective combination antiretroviral therapy (cART) may be sufficient in some cases to decrease the incidence or beneficially influence the course of some cancers, in other cases it fails to control cancers in people living with HIV/AIDS. Currently, more than a decade after the widespread introduction of cART, and after major advances in the basic understanding of cancer signaling pathways, we have a unique opportunity to revisit the pathobiology, epidemiology and treatment options for malignancies in people living with HIV/AIDS. Molecular Basis for Therapy of AIDS-Defining Cancers provides a primer on the science of cancer in the setting of HIV infection, as well as examples of novel treatment approaches for HIV-associated neoplasia.