Malignancy in HIV/AIDs: A single hospital experience

Background and Objectives: Our hospital serves an area with a significant n umber of patients seropositive for the human immunodeficiency virus (HIV). Intravenous drug abuse and heterosexual exposure are by far the predominant risk factors for HIV and acquired immunodeficiency syndrome (AIDS). Seven percent of these patients develop malignancies. Our aim was to study the ty pes of tumor, their distribution, and to evaluate the patients' outcome. Methods: Of 3,578 patients with HIV infection or AIDS treated between 1993 and 1998, 245 had 1 or more malignancies. Information was collected on age, sex, race, predisposing risk factors for AIDS, malignancies, symptoms at p resentation, the time of the onset of AIDS, CD4 cell counts, pathology find ings, and mortality. Results: Although aspects of our patients resembled those of previously stu died groups of patients with AIDS, there also were ways in which our patien ts differed from those other groups. Of our patients, 21.6% had non-AIDS-de fining (NAD) invasive malignancies. This was considerably higher than the r ate in most studies. Twenty-seven patients with such malignancies died duri ng the study. Forty-two other patients had preinvasive cancers. Among patie nts having AIDS-defining (AD) malignancies, 55.9% died, a fact that was rel ated to patients' low CD4 cell counts and late presentation. Our 97 patient s with Kaposi sarcoma included 22 women, a relatively high number that may be related to the fact that most of our patients were intravenous drug abus ers or had become infected by heterosexual transmission of HIV. Conclusions: AIDS is associated with a high risk of malignancy and an unusu al spectrum of tumors. Patients with invasive tumors have advanced disease at the time of initial presentation. Those with AD tumors have a worse prog nosis than patients with NAD tumors. The impact of highly active antiretrov iral therapy on both AD and NAD tumors needs to be further evaluated. J. Su rg. Oncol. 2000;75:11-18. (C) 2000 Wiley-Liss, Inc.