Cancers in People with HIV and AIDS: Progress and Challenges

385 Pages·2014·5.54 MB·English

by  Robert Yarchoan (eds.)

Robert Yarchoan Editor
Cancers in
People with
HIV and AIDS
Progress and Challenges
Cancers in People with HIV and AIDS

Robert Yarchoan
Editor
Cancers in People with HIV
and AIDS
Progress and Challenges
This book is an expansion of the section,
Opportunistic Malignancies, in the Encyclopedia of AIDS,
editors-in-chief Thomas J. Hope, Douglas D. Richman,
and Mario Stevenson.
Editor
Robert Yarchoan
HIV and AIDS Malignancy Branch and
Offi ce of HIV and AIDS Malignancy
National Cancer Institute
National Institutes of Health
Bethesda , MD , USA
ISBN 978-1-4939-0858-5 ISBN 978-1-4939-0859-2 (eBook)
DOI 10.1007/978-1-4939-0859-2
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2014942269
© Springer Science+Business Media New York 2014
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Pref ace
The fi eld of HIV-associated cancer has undergone a number of changes and advances
in the past several years, and this book was conceived to fi ll the need for a resource
that summarizes this new information. The 28 chapters describe the current state of
knowledge in this area. These chapters were written by some of the most renowned
experts in this fi eld, and they cover a wide array of topics, including epidemiology,
pathogenesis, clinical manifestations, and treatment.
F rom the earliest days of the AIDS epidemic, it was evident that cancer was a
major part of this new disease—many of the patients had Kaposi sarcoma or aggres-
sive lymphomas, which along with cervical cancer were called “AIDS-defi ning.”
For reasons that were not well understood, only certain tumors seemed associated
with AIDS, and most developed in patients who were profoundly immunosup-
pressed. Since that time, our understanding of HIV-associated cancers has increased
dramatically. With the discovery of Kaposi sarcoma-associated herpesvirus and its
identifi cation as the cause of Kaposi sarcoma, it became apparent that many AIDS-
associated cancers are caused by other viruses. In addition, we have seen dramatic
changes in the AIDS epidemic itself. The development of highly active antiretrovi-
ral therapy (HAART), also called combination antiretroviral therapy (cART),
around 1996 profoundly changed AIDS from a death sentence to a treatable disease.
Patients had dramatic improvements in their immune function, and the incidence of
AIDS-associated tumors decreased. In fact, there was a sense that HIV-associated
cancer was no longer a major problem. Nothing could be further from the truth.
With the introduction of HAART, people with AIDS started living longer. Along
with this, the number of persons living with AIDS has increased, and this popula-
tion in general has gotten older. With these changes in the epidemic, the scope of
HIV-associated tumors has changed. In addition to the more classic AIDS-defi ning
tumors, patients with HIV infection are now developing more HIV-associated
tumors, such as lung cancer, anal cancer, Hodgkin disease, and liver cancer. The
factors causing the increase in these tumors vary, and each cancer is its own unique
story. Also, as HIV-infected patients are less likely to die of AIDS-associated oppor-
tunistic infections or AIDS, cancer is now becoming a leading cause of death in this
population. The story of HIV-associated cancers is somewhat different in the
v
vi Preface
developing world, and especially in sub-Saharan Africa. Many of the cancers
associated with AIDS, such as Kaposi sarcoma, were common in sub-Saharan
Africa even before the AIDS epidemic, and fueled by HIV, several of these cancers
are among the most common in this region and pose substantial public health chal-
lenges. Also, patients in this region are susceptible to a number of uncommon HIV-
associated cancers not often seen in the USA or other more developed countries.
Along with this evolution of the epidemic and increased awareness of HIV-
associated cancers in sub-Saharan Africa, there has been a dramatic increase in our
knowledge about and understanding of these tumors. Even so, a number of chal-
lenges remain, and better means to prevent, diagnose, and treat these tumors are
urgently needed. With this backdrop, it is timely to present a book summarizing the
current state of information about HIV-associated tumors. This project grew out the
Springer Encyclopedia of AIDS, in which I edited the section on Opportunistic
Malignancies. As I organized this section, it soon became apparent that a separate
book covering this material would be of value and that the authors who contributed
to the Encyclopedia were the best to pull this effort together. The space in the
Encyclopedia was limited, and for the book, each contributor was given the oppor-
tunity to expand and update their contribution and to increase the number of refer-
ences as they saw fi t. This book is the result of that effort.
Bethesda, MD, USA Robert Yarchoan
Acknowledgments
I would like to thank and acknowledge all the contributors who took time out of
their busy clinical and research efforts to write excellent chapters for this book.
I also want to thank my mentors over the years and my colleagues in the National
Cancer Institute. I would like to acknowledge the many medical researchers, physi-
cians, and other medical personnel who have helped advance this fi eld and care for
patients with HIV-associated cancers, and just as importantly, the patients who have
volunteered to participate in clinical studies. I want to take this opportunity to thank
the NCI for supporting me throughout my research career. I would like to especially
thank my wife and collaborator, Dr. Giovanna Tosato, who has provided insights
and encouragement over many years. Finally, I wish to dedicate this book to my
parents, Anne and Zachary, and my two sons, Mark and John.
vii

Contents
Part I Overview and Epidemiology
1 HIV-Associated Cancers ......................................................................... 3
Robert Yarchoan , Thomas S. Uldrick , and Mark N. Polizzotto
2 Epidemiology of AIDS-Defi ning Malignancies ..................................... 17
William A. Blattner and Rebecca G. Nowak
3 The Epidemiology of Non-AIDS-Defi ning Malignancies..................... 31
Andrew E. Grulich
4 HIV Cancers in Resource-Limited Regions.......................................... 43
Sam M. Mbulaiteye
Part II Oncogenic Viruses Causing HIV- Associated Cancers
5 Kaposi Sarcoma-Associated Herpesvirus (KSHV)
or Human Herpesvirus 8 (HHV-8) ........................................................ 61
Blossom Damania and Dirk P. Dittmer
6 Epstein–Barr Virus ................................................................................. 75
Lindsey Hutt-Fletcher
7 Human Papillomaviruses ....................................................................... 87
Zhi-Ming Zheng
8 Merkel Cell Polyomavirus ...................................................................... 113
Nicole Fischer and Adam Grundhoff
ix