Módulo 2 – Curso pós-graduado – VIH e Envelhecimento

Non-AIDS Defining Cancers Among HIV Infected People

Risk factors for non-AIDS defining malignancies

Autor: Prof. Doutor Mark Bower, MD PhD (National Centre for HIV malignancy Chelsea & Westminster Hospital, London, UK)

Oncogenic virus and NADMs

IMost NADMs cases are related to oncogenic infections by HPV, EBV, hepatitis viruses (HBV and HCV) and Helicobater pylori, whilst a minority of NADMs have no identified infectious cause. The higher prevalence of cigarette smoking amongst people living with HIV may account for the increase in lung cancer, as well as leukaemia and kidney cancer, for instance. However, in some cases, it’s not absolutely clear why these NADMs are occurring more frequently in patients living with HIV7.

Merkel-cell tumours are very rare and very aggressive skin cancers that metastasise early and widely. An early epidemio- logical study showed that amongst 300,000 people with AIDS, there were six patients who developed Merkel-cell tumours, with a relative risk of 13-fold compared to the matched general population8. Patrick Moore and Yuan Chang, the couple who discovered the Kaposi sarcoma herpesvirus, also identified the Merkel-cell polyomavirus in samples from these tumours9. This is the first human oncogenic polyomavirus and can be detected in the Merkel-cell cancers, but not in other skin cancers. Furthermore, the Merkel-cell polyomavirus gets integrated into the human genome, and the point of integration is exactly the same in the primary tumour, in the nodal metastases, and in the distant metastases, implying that the virus infected the tumour cells before they underwent clonal expansion as a cancer. Finally, this virus when in tumours, always carries a mutation in the large T antigen, which is an oncogene.

At the Chelsea & Westminster Hospital, a total of 2738 peo- ple living with HIV have developed cancers, between 1985 and 2015, and 25% of cancers were NADMs. Most of the patients who developed NADMs were male and the mean age at the time of the cancer diagnosis was 48 years. This reflects the demographics of our HIV patient population, which is predominantly composed of men who have sex with men (MSM) in London. From 431 patients analysed, only 30 (7%) developed NADMs before the introduction of HAART.

The incidence of NADMs per years has risen steadily. At the time of NADM diagnosis, about a third (37%) of the patients had already had an AIDS defining diagnosis but the median CD4+ cell count was 379 cells/mm3. Three quarters of the pa- tients were on ART of whom 86% had undetectable viral loads. Thus, despite having well controlled HIV infection, they still de- veloped NADMs. Regarding the spectrum of NADMs, the majority were Hodgkin lymphoma (23%) or anal cancer (21%), followed by non-melanoma skin cancers (18%), lung cancer (11%), among other NADMs (27%). In fact, 61% of all of these cancers could be attributed to oncogenic viruses and bacteria.

Logo MSD Termos de utilização | Política de Privacidade | Sobre a MSD Copyright © 2018 Todos os direitos reservados. Merck Sharp & Dohme Corp.,uma subsidiária da Merck & Co., Inc. Kenilworth, NJ, USA, conhecida fora dos EUA e Canadá como MSD. Os conteúdos disponibilizados nesta página Web são informação de carácter geral e não substituem em nenhum caso as consultas, tratamentos ou as recomendações do seu médico. INFC-1273571-0000 11/2018