Impact of HAART on the clinical management of AIDS-related cancers

The development of HIV-related disease has changed dramatically since the i ntroduction of highly active antiretroviral therapy (HAART) into clinical p ractice. Since the use of protease inhibitors became widespread, a 30-50% r eduction in Kaposi's sarcoma (KS) has been observed. The results of recent studies indicate that HAART may be a useful alternative both to immune resp onse modifiers during less aggressive stages of KS disease and to systemic cytotoxic drugs in the long-term maintenance therapy of advanced KS. The im pact of HAART regimens on the incidence of systemic lymphoma (NHL-HIV) rema ins unclear, but it can be hypothesised that patients treated with HAART ma y survive longer with continued B cell stimulation and dysregulation result ing in an increased incidence of lymphoma over time. The impact of HAART on survival in patients affected by NHL-HIV has recently been evaluated and a positive correlation between HAART and outcome in these patients has been found. The spectrum of cancers in patients with HIV infection may develop f urther since these patients survive longer with HAART and with a better con trol of opportunistic infections. With the increasing use of HAART, the dil emma is whether to institute or continue protease inhibitors use during che motherapy. Based on the advances in our understanding of HIV-related diseas e and the availability of new antiretroviral therapies, the choice for anti -HIV agents in patients receiving chemotherapy is important. (C) 2001 Elsev ier Science Ltd. All rights reserved.