Cancer and AIDS are perhaps the two most terrible diagnoses a person can hear. Both are incurable, cause a lot of suffering and require gigantic efforts to even slightly prolong life. Needless to say, the situation is deplorable when a malignant neoplasm and HIV are detected together in one patient.

HIV infection provokes the development of malignant neoplasms - a weakened immune system “does not see” and cannot fight bad cells that begin to divide uncontrollably, turning into a tumor. There are a number of pathologies that are classified as AIDS-associated:

• Kaposi's sarcoma (hemorrhagic sarcomatosis);
• cervical cancer (caused primarily by infection with papillomavirus in HIV patients);
• non-Hodgkin's lymphomas;
• lymphoma of the central nervous system.

The presence of these diagnoses in an HIV-infected patient indicates the terminal stage of immunodeficiency - AIDS. There are also groups of diseases, the incidence of which is higher in HIV-positive patients, regardless of the degree of immunosuppression:

• rectal cancer;
• cancer of the oral cavity and pharynx;
• skin neoplasms;
• lungs' cancer.

According to statistics, up to 40% of HIV patients have some kind of malignant neoplasm.

Cancer risk and HIV infection

Large scientific studies have shown that the risk of developing cancer in HIV for specific nosologies is several, and sometimes several tens of times, higher than in HIV-negative patients. For example, the risk of a rectal tumor is 55 times higher, and Kaposi's sarcoma is 200 times higher. Scientists note that HIV and cancer, as a secondary concomitant disease, are more common in drug addicts, alcoholics or people who have refused antiretroviral therapy. Smoking with HIV increases the risk of developing cancer of the lip, pharynx or lungs several hundred times.

Features of HIV therapy for cancer

If an HIV-positive cancer patient receives chemotherapy or radiation therapy, this primarily affects the immune system - the toxic effect of the treatment affects the composition of the blood, cell renewal and the level of lymphocytes. This may reduce the effectiveness of antiretroviral therapy. On the other hand, patients with HIV have low tolerance to chemotherapy - more and more severe complications, less therapeutic effect. When taking ART and drugs for the treatment of oncology simultaneously (immunotherapy, biotherapy, chemotherapy, antibacterial agents), their chemical interaction is possible, which leads to:

• increased load on the liver and kidneys;
• decreased effectiveness of drugs;
• possible formation of toxic compounds.

Oncological surgeries for HIV

A blood test for HIV antibodies is mandatory before any surgery. But the patient’s HIV-positive status is not a contraindication to surgery, but simply requires additional safety measures for medical personnel. Surgical treatment of cancer in HIV is carried out according to the same standards as in HIV-negative patients, but has some features:

• assessment of the level of CD4 lymphocytes to determine the stage of immunodeficiency and the body’s ability to recover after surgery;
• mandatory control of concomitant infections - if the disease is in the acute phase, then antibacterial (antiviral, antifungal - depending on the pathogen) therapy is necessary before surgery and stabilization of the process;
• assessment of the severity of the patient’s condition and the presence of concomitant chronic pathologies of the cardiovascular and excretory systems.

Recovery after surgery for immunodeficiency is somewhat more difficult - incisions take longer to heal, often fester and become inflamed, and functional indicators return to normal more slowly. But surgical treatment of cancer for HIV, as far as possible, prolongs the patient’s life and improves the quality of life.

Doctors at the Cancer Center at Children's Hospital in Philadelphia (USA) have made a real breakthrough in medicine by learning to treat cancer with HIV. Experts conducted research in the field of genetic engineering and were able to reprogram the deadly virus. Thus, in three weeks, HIV cured a girl who had two days to live, reports CBS.

Seven-year-old Emily Whitehead from New Jersey battled lymphoblastic leukemia for two years. Doctors prescribed her radiation and chemotherapy sessions, but there were no visible results. In the end, the girl felt a little better, but right before the difficult operation for a bone marrow transplant, she had a relapse. Then the doctors put an end to the possibility of recovery. Emily had only days left before her organs would fail.

Then the parents moved the girl to the children's hospital in Philadelphia, which is famous for one of the best cancer centers in the United States. The center's director, Stefan Grup, offered the parents an experimental but promising treatment called CTL019 therapy.

The essence of the method is that scientists modify the HIV virus. Its genetic code is altered so that the infected T cell attacks cancerous tissue while sparing healthy tissue. Healthy lymphocytes do not participate in the fight at all. Infected T cells recognize cancer cells thanks to a specific protein called CD19. The treatment is incredibly dangerous: infection is accompanied by the final decline of an already weakened immune system, as well as terrible pain. Emily had little chance of surviving the first night after the operation, but without intervention the girl would not have survived two days.

After the introduction of the modified virus, Emily's condition improved in just a few hours. Doctors noted that she began to breathe more smoothly, and her temperature and blood pressure returned to normal. To the surprise of the doctors, after three weeks there was no trace of cancer left. Six months have passed since the completion of the course, which was carried out in April, but there are still no traces of cancer in the baby’s body. Infected T cells protect the body and now this is another advantage of the new treatment method over traditional methods.

An additional 12 patients were treated with CTL019 therapy. Nine of these attempts ended positively. Two other children who took part in the studies also experienced complete remission.

Despite the fact that the cost of treatment is quite high (20 thousand dollars per session), scientists hope that this method will develop, become more accessible and help millions of people who have lost hope. It is likely that over time this procedure will eliminate the need for an expensive bone marrow transplant.

Emily's parents are extremely proud of their brave daughter, who seemed to be less afraid than others and fought her illness to the last. Now the girl leads a normal life - goes to school, plays, which her family is very happy about.

A person with the immunodeficiency virus is a very vulnerable target for a variety of dangerous diseases, because the disease greatly weakens the body. This is why HIV and cancer are often interrelated.

Cancer in HIV-infected people is called associated, since the detection of one disease may indicate the presence of another. The doctor will definitely prescribe an HIV test for oncology, especially if the patient is diagnosed with:

• Kaposi's sarcoma.
• non-Hodgkin's lymphoma.
• invasive cervical cancer.

Statistically, patients diagnosed with AIDS have a 25% higher risk of developing rectal cancer and a 10% higher risk of liver cancer than healthy people.

From a medical perspective, a dual diagnosis of HIV and cancer complicates the treatment of both diseases. Potential side effects are several times more severe, and radiotherapy and chemotherapy can be fatal.

From a psychological point of view, a diagnosis of HIV infection and cancer can lead to severe depression in the patient. In particular, patients with HIV/AIDS receive less social support, largely due to the association of the immunodeficiency virus with homosexuality and drug use.

To determine the treatment program for cancer of a patient with an immunodeficiency virus, an immunologist and oncologist carefully study the medical history. The patient is usually managed by a whole team of medical specialists:

• nurse from the oncology department.
• Social worker.
• psychologist.
• infectious disease specialist

The treatment program depends on a number of factors, including the type and stage of the disease, the patient's immune system, and the severity of existing AIDS symptoms. If AIDS has weakened the body too much, then cancer treatment may be aimed at reducing the manifestation of negative symptoms rather than destroying the tumor.

Treatment of cancer due to HIV infection is difficult due to the increased risk of complications, especially a critical decrease in the level of white blood cells and complete suppression of the immune system.

Due to the fact that HIV and oncology combined give a negative prognosis, first of all, the treatment program will be aimed at overall improving the quality and life expectancy of the patient. This type of therapy is called palliative. Palliative treatment methods include the use of medications, a special diet, regular communication with a psychotherapist, and physical therapy. If the patient's condition is stable, then palliative treatment is supplemented with chemotherapy, surgery, or radiation therapy.

Reviews and comments

And not a single offer to pleas for help. Until they themselves find themselves in a similar situation, they won’t even scratch it.

Today my husband was denied treatment. He has esophageal cancer and HIV infection. How can I cure him? Help.

His name is AIDS Vyacheslav Zalmanovich Tarantul

Cancer is a product of AIDS

Cancer is a product of AIDS

The causes of all the above-described diseases accompanying AIDS are more or less clear: the immune system is impaired and all pathogenic microorganisms around us multiply freely in a sick body; The shield has disappeared - and numerous, previously hidden enemies are now triumphant! After all, it is known: leonem mortuum etiam catuli mordent (even puppies bite a dead lion). The situation is more complicated with another type of concomitant disease, which is no less terrible than AIDS - cancer.

Almost immediately after the first diagnosis of AIDS, it became clear that this disease is closely associated with the development of certain types of malignant transformations. Further statistics showed that quite often people infected with HIV get cancer. It also became clear that HIV provokes its appearance. True, not all of the numerous types of cancer known today affect AIDS patients, but only some of them. These, called indicator tumors, characteristic of AIDS, include primarily Kaposi's sarcoma (affects the skin and internal organs) and primary non-Hodgkin's lymphomas of the brain or other localization. They can even be considered as a diagnostic sign: if a patient has them, then this most likely indicates the presence of HIV. Before we talk about these cancers, let's make one more small digression.

A little history

The problem of cancer has plagued humanity since time immemorial. The legend connects the appearance of the word “cancer” to denote a certain group of diseases with the ancient ideas about the cause of this pathology: when a person drinks water from a river, the pathogen enters his body and then eats it away from the inside (Latin cancer - river crayfish). For a long time, it remained unclear what causes cancer to develop. In 1910, I. I. Mechnikov was one of the first to suggest that there are two causes of malignant degeneration, “one of which is in the body itself, but the other enters it in the form of an exogenous source, most likely a virus.” That some cancers in animals are caused by viruses became apparent a year later when Routh showed that the virus that would later be named after him, Rous' sarcoma virus, caused a form of cancer, sarcoma, in chickens. Many years passed until Routh received the Nobel Prize for his epoch-making discovery (1966). The main thing is that he lived to see it. After Routh's discovery, rabbit papillomavirus (R. Shoup, 1932) and mouse mammary gland tumor virus (J. Bitner, 1936) were isolated. Thus, it gradually became clear that at least some viruses could cause cancer. In the mid-40s. last century, the famous Soviet microbiologist L. Zilbert proposed a virogenetic theory of cancer, according to which “the role of the virus in the development of the tumor process is that it changes the hereditary properties of the cell, turning it from normal to tumor, and the tumor cell thus formed serves as a source of growth tumors; the virus that caused this transformation is either eliminated from the tumor due to the fact that the changed cell is an unsuitable environment for its development, or loses its pathogenicity and therefore cannot be detected during further tumor growth.”

Since then, using various viruses, hundreds of types of tumors have been reproduced in animals. However, the role of viruses as one of the main causes of certain forms of cancer in humans was finally confirmed only in the mid-70s - early 80s. The main evidence for the integration of viral and cellular genomes was the discovery of reverse transcriptase by G. Temin and D. Baltimore, the experiments of Renato Dulbecco in identifying viral DNA as an integral part of cellular DNA in tumors, and the establishment by D. Bishop and G. Varmus of the fact that special genes (oncogenes) ), contained in some viruses, are cellular genes that viruses pick up from higher organisms during reproduction in cells. All these scientists subsequently became Nobel laureates in physiology and medicine (R. Dulbecco, H. Temin and D. Daltimore in 1975, and D. Bishop and G. Varmus in 1989).

Although it is now clear that not all types of tumors are caused by viruses, the viral nature of a number of them is beyond doubt. Recently, a possible close relationship has been observed even between the malignant degeneration of cells and infection by bacteria. We are talking about the bacterium Helicobacter pulori. According to some researchers, this bacterium, “responsible” for the development of stomach and gastrointestinal cancer, has existed for almost 11 thousand years. According to some scientists, the “longevity” of this bacterium in the human body is determined by the fact that it has a positive effect on the body.

In general, today it is believed that at least 15% of all cancer cases in the world are the result of various chronic infectious diseases. Let us list the main viruses that are currently associated in one way or another with various forms of cancer:

Hepatitis B virus;

Hepatitis C virus;

Human papillomavirus;

Human T-cell leukemia virus;

Epstein-Barr virus;

Human herpesvirus-8;

AIDS virus.

Note that the hepatitis C virus, T-cell leukemia virus and HIV are RNA-containing viruses, while the genetic apparatus of other viruses, like most other living organisms, consists of DNA. This list cannot yet be considered completely exhausted. It cannot be ruled out (and most likely this will be the case) that in the future we will still face the discovery of other DNA and RNA viruses that, as scientists say, have oncogenic potential, i.e., capable of causing cancer. In all cases, currently known viruses do not directly cause cancer in humans, but their very presence makes cells more prone to malignant transformation, or the viruses damage or change the functioning of normal human genes, which leads to an acceleration of this process.

It is now quite clearly established that the main cause of primary liver cancer throughout the world is chronic infection with hepatitis B and C viruses. The presence of a specific enzyme in the hepatitis B virus - DNA polymerase, which has the function of reverse transcriptase, allows us to call it a “hidden” retrovirus. Hepatitis B virus is the most variable DNA virus, which is similar to the highly variable HIV. Doctors attribute about 80% of all cases of liver cancer in the world to the hepatitis B virus. This disease affects about a quarter of a million people every year (especially in several countries in Africa and Asia).

The hepatitis C virus, like the hepatitis B virus, can cause some cancers, such as malignant diseases of the immune system and thyroid gland, but mainly liver cancer. Scientists have called the hepatitis C virus the “silent killer” for its hidden, slowly progressive course, difficulty of detection and virtual lack of self-healing. When infected with the hepatitis C virus, the traditional sequence of changes in the liver is clearly observed: acute viral hepatitis - chronic hepatitis - cirrhosis - liver cancer. It is believed that the mechanism of destructive action of hepatitis C and B viruses is different, although patients do not need to delve into these subtleties. For them, the main thing is the result, and it is disappointing: long-term chronic viral hepatitis, which has already passed into the last stage, the stage of liver cirrhosis, is fraught with further development of cancer. The prevalence of hepatitis C is extremely high, especially among drug addicts and people who have undergone blood transfusions.

Another virus, the human papillomavirus, is considered one of the main causes of cervical cancer, as well as some other types of mucosal and skin cancer. Infection with this virus is one of the most common sexually transmitted diseases and is estimated to cause cancer in over 10% of women.

Another oncogenic virus, human T-cell lymphotropic virus type I, infects T lymphocytes (a type of white blood cell that is part of the body's immune system) and causes some T-cell lymphomas. However, the incidence of such virus-related lymphomas in the general population is low.

With the discovery of HIV, it also began to be considered as one of the causes of cancer.

Long-term observations by doctors have revealed a clear relationship between HIV infection and certain types of malignant diseases. The most common types of cancer in HIV-infected patients are shown in Fig. 25. Their frequency in HIV carriers increases tens and thousands of times compared to the frequency of such diseases among uninfected people. Even at the beginning of the epidemic, it was noted that an increase in HIV infection leads to an increase in the incidence of cancers such as lymphoma and Kaposi's sarcoma. Kaposi's sarcoma got its name from the Austrian M. Kaposi, who described it for the first time in 1874. For many years, this disease was considered to be extremely rare. Kaposi's sarcoma was mainly found in elderly men living in the Mediterranean and Central Africa. After some time, it became clear that the increased incidence of this disease is closely related to immune deficiency. After the start of the HIV epidemic, this was finally confirmed. Starting from the first years of the epidemic, Kaposi's sarcoma began to be considered as one of the main indicators of the presence of HIV and began to be classified as an AIDS-associated disease. It is believed that it is not HIV that plays an important role in the development of this pathology, but other viruses, in particular one of the herpes viruses, called human herpes virus type 8 (HHV8). The growth of sarcoma causes large lesions located on the face, which greatly disfigures the person, and those located on the legs or in the joint area limit physical activity. But Kaposi's sarcoma itself rarely causes death in HIV-infected people. Initially, Kaposi's sarcoma occurred in almost a third of HIV-positive people. But then the incidence of Kaposi's sarcoma in people with HIV decreased significantly, and this decrease coincided with the widespread use of highly active antiretroviral therapy for gay/bisexual people to treat HIV infection (this therapy and its successes will be discussed later).

Rice. 25. Some malignant diseases are constant companions of HIV infection. The occurrence of some of them (lymphoma, Kaposi's sarcoma) serves as an indication to doctors that the patient may have HIV infection. In parentheses in the figure it is indicated how many times more often the corresponding malignant diseases develop in HIV-positive people compared to the population of uninfected people

Another oncological disease that is closely related to AIDS (i.e., is an indicator) is lymphoma, especially some of its varieties, the so-called non-Hodgkin lymphomas and primary lymphomas of the central nervous system (Fig. 25). Lymphoma is the second most common tumor after Kaposi's sarcoma in patients with HIV infection. Typically, this type of tumor occurs in later stages of the disease. Approximately 12–16% of AIDS patients die from lymphoma. Unlike Kaposi's sarcoma, lymphoma is not associated with any specific risk group. The prevalence of lymphomas in HIV-infected patients is estimated to range from 3 to 12%, which is approximately 100–200 times more common than in the general population. And one form of lymphoma, called Burkitt's lymphoma, occurs 1,000 to 2,000 times more often in HIV-infected people than in uninfected people. Symptoms of lymphomas are fever, sweating, weight loss, damage to the central nervous system, accompanied by epileptic seizures. Unlike Kaposi's sarcoma, lymphomas usually kill patients within one year of their onset.

As HIV infection progresses and spreads across different populations, other types of cancer begin to appear with increasing frequency. In addition to the two “main” types of cancer usually diagnosed in immunocompromised patients, malignancies such as small cell lung carcinoma, colon adenocarcinoma, testicular seminoma, and even basal cell carcinoma, the most common form of skin cancer in HIV-infected people, have begun to be discovered. There are also reports of an increase in the incidence of cervical cancer and melanoma in patients with HIV infection. In AIDS, cervical cancer, most likely associated with infection with the human papillomavirus, has become one of the significant causes of death in infected women.

The real mechanisms of malignant transformation under the influence of HIV still remain unknown. There is only a general understanding of the relationship between the development of cancer and the suppression of the normal function of the immune system by the virus. But perhaps individual HIV proteins also purposefully interfere with this process. In particular, transgenic animal models have shown that some HIV genes encode proteins with oncogenic potential. Transgenic are organisms in which all cells contain some additional gene, artificially introduced by scientists. Today there is a lot of talk and debate around transgenic products, i.e. food products obtained from transgenic organisms. But this is a special question. Molecular geneticists use transgenic animals for completely different purposes. By transferring individual HIV genes into the genetic apparatus of mice and analyzing the health status of transgenic animals, scientists can draw certain conclusions about their independent function in the body. Based on such experiments, it was concluded that one of the causes of cancer in HIV-infected people is a protein encoded by a viral regulatory gene called tat (already discussed above). This protein regulates the functioning of not only viral genes. It actively interferes with the metabolism of cells, not only those infected with the virus, but also those sometimes located at a fairly large distance from them. By disrupting the normal metabolism in the cell, it can itself cause malignant degeneration. These are the most likely causes of cancer development in HIV-infected patients.

Nervous system damage

Immune deficiency resulting from HIV infection is usually accompanied by the development of a number of concomitant pathologies: neuropathy, enteropathy, nephropathy, myopathy, impaired hematopoiesis, and tumor formation.

It has already been noted that HIV often affects the brain, and to the same extent as the immune system. Between one third and half of its victims suffer from various severe neurological diseases. Damage to brain tissue varies from minor changes to severe progressive ones. Since 1987, nervous system disorders have been officially recognized as another symptom of AIDS.

Neurological, and then mental disorders, are such formidable companions of AIDS that in these cases there is no need for an “army of hired killers,” i.e., causative agents of secondary infections. The virus itself has the ability to infect cells of the central nervous system, and the pathogen does this so skillfully and often that the brain form of AIDS can be safely placed in second place in terms of frequency. However, AIDS-associated infections may also play an important role in neurodevelopmental disorders in HIV-infected people. Most often, the pathological process is determined by infections such as cryptococci, toxoplasma, candida, cytomegalovirus, and tuberculosis complex bacteria.

Neurological lesions may be associated in some cases with disorders of the brain, in others - of the spinal cord, in others - of the membranes, and in others - of peripheral nerves and roots. Symptoms of the pathology depend on the location of the lesion. Neoplasms, such as, for example, primary lymphoma of the central nervous system, also make a certain contribution to the pathology of the nervous system.

Neurological patients are usually bothered by headaches, anxiety with depression, imbalance, decreased visual acuity, and memory impairment. They, as a rule, lose orientation in time and space, lose the ability to contact the external environment, and ultimately often die in a state of complete insanity and personality disintegration. In particular, the so-called AIDS dementia syndrome, which develops in approximately a quarter of patients affected by the virus, is considered one of the diagnostic signs of HIV infection. The name of this pathology comes from the word dementia - that is, a progressive decline in intelligence. At the same time, attention is impaired, memory deteriorates, and a manic state gradually develops. In a number of its symptoms, this syndrome resembles Parkinson's disease. Another neurological pathology often found in HIV-infected people is serous meningitis. Its typical syndromes are headache, photophobia.

For a long time, the cause of damage to the nervous system during HIV infection remained unclear. It was recently discovered that this effect may be due to HIV proteins. At least one of them (the already mentioned gp120 envelope protein), when acting on neurons, triggers the process of apoptosis in them, i.e., a special mechanism of cell death.

Lesions of the gastrointestinal tract

Another weak point in HIV infection is the gastrointestinal tract. It is constantly involved in the pathological process caused by HIV and can be affected at various stages of the disease. This is due to the fact that some cells of the gastrointestinal tract serve as a target for the virus. HIV is found in various cells not only of the rectal mucosa, especially in homosexuals, but also in all parts of the intestine, even in cells that do not have CD4 receptors. Obviously, the penetration of the virus into tissue occurs through intercellular exchange. The virus itself causes degenerative changes in the crypts and microvilli of the intestine, as a result of which parietal digestion and absorption of useful products are disrupted. Not only a purely structural disturbance of the intestinal wall occurs, but also a decrease in its stability (resistance) and the development of dysbiosis. The nature of the lesion can be either diffuse or local in the form of inflammation of different parts of the gastrointestinal tract: oral mucosa (stomatitis), esophagus (esophagitis), duodenum (duodenitis), small intestine (enteritis), colon (colitis), rectum intestines (proctitis), etc. One of the most characteristic clinical manifestations of damage to the gastrointestinal tract during HIV infection is diarrhea (in everyday life - diarrhea), which is observed in 70% of patients.

Some types of cancer are so common in people with AIDS that they are considered AIDS-defining diseases—meaning that their presence in an HIV-infected person is a sign that the person is developing AIDS. These cancers are also called AIDS-associated cancers, which include:

• Kaposi's sarcoma
• Lymphoma (especially non-Hodgkin's lymphoma and central nervous system lymphoma)
• Invasive cervical cancer

Other cancers that are more likely to develop in people with HIV include: invasive anal cancer, Hodgkin's disease, lung cancer, oral cancer, testicular cancer, skin cancers including basal epidermocyte and squamous cell carcinoma, and malignant melanoma . Of course, HIV-negative people can also suffer from these diseases, even those that are considered AIDS-related. But they are called as such only when they occur in HIV-positive patients.

In developing countries, 4 out of 10 people with AIDS will develop cancer at some point during their illness. However, the overall picture of cancers in HIV-infected people is changing. With the spread of antiretroviral treatment, the incidence of Kaposi's sarcoma and non-Hodgkin's lymphoma has decreased. Most other cancers have not slowed down due to anti-HIV treatment, and their risk factors remain the same as in healthy people. For example, HIV-positive smokers are more likely to develop lip, mouth, throat and lung cancers than healthy non-smokers.

The relationship between HIV and other cancers is still not fully established. However, it is believed that cancer develops faster in people with immune systems weakened by HIV. Unfortunately, cancer in people living with HIV is more difficult to treat, in part due to HIV's weakened immune system and reduced white blood cell count, both of which are a direct result of HIV infection. Going through chemotherapy can be difficult for people with AIDS because the bone marrow, which is supposed to produce new blood cells, is sometimes already damaged by HIV infection. Patients with this problem often cannot complete a full course of chemotherapy without causing serious harm to themselves. The introduction of highly active antiretroviral therapy (HAART) in the late 1990s led to a decrease in the incidence of some types of cancer in HIV-infected people and increased the life expectancy of AIDS patients. This also allowed HIV-positive patients to undergo full courses of chemotherapy in case of cancer. Currently, alternative cancer treatment methods based on monoclonal antibodies and stem cell transplantation are being developed for HIV-infected people.

AIDS-associated Kaposi's sarcoma

Kaposi's sarcoma (KS) was once a rare disease that predominantly affected older men of Mediterranean or Jewish descent, organ transplant patients, or young people from Africa. This form is called classic SC. However, in the 1970s and 80s the number of people with KS increased rapidly

Over the past 25 years, most cases of KS in the United States have been associated with HIV infection in men who have sex with men. These cases belong to epidemic KS. It is now known that KS in HIV-infected people is associated with another viral infection. It is caused by a virus called human herpes virus 8 (HHV-8), also known as Kaposi's sarcoma-associated herpes virus. HHV-8 does not cause illness in most HIV-negative people. Infection with this virus is common in the United States among men who have sex with men, although it can also be transmitted during sex between men and women. The virus was found in saliva, which means it can be transmitted during deep kisses.

In most cases, epidemic KS causes dark purple or brownish malignant growths of the dermis (called lesias) that can appear in various places on the body. Such growths can occur on the skin or in the mouth, and damage lymph nodes and other organs such as the digestive tract, lungs, liver and spleen.

During initial diagnosis, some people with epidemic KS show no other symptoms, especially if the lesions occur on the skin. However, many, even without skin lesions, experience enlarged lymph nodes, unexplained fever or weight loss. Over time, the symptoms of epidemic KS spread throughout the body. If KS affects a large area of ​​the lung or intestine, it can lead to fatal consequences.

Typically, patients diagnosed with epidemic KS are prescribed antiretroviral drugs and anticancer treatment.

Lymphomas

Non-Hodgkin's lymphoma (NHL) affects 4-10% of AIDS patients. This is a cancer that begins in the lymphoid tissue and can spread to other organs. Since the introduction of antiretroviral therapy, the number of HIV-infected people who develop lymphoma has decreased significantly, although not as much as the number of patients with Kaposi's sarcoma.

Non-Hodgkin's lymphomas, which commonly occur in patients with AIDS, are often primary lymphomas of the central nervous system (CNS). Primary CNS lymphoma begins in the central or spinal cord. Symptoms of primary CNS lymphoma may include seizures, facial paralysis, confusion, memory loss, and drowsiness (fatigue). AIDS-associated non-Hodgkin's lymphoma can also provoke the development of other moderate-to-high-grade lymphomas, including Burkitt's lymphoma.

The prognosis or outcome for patients with AIDS-associated non-Hodgkin's lymphoma depends partly on the type of lymphoma and partly on the function of the patient's immune system. Patients with generalized non-Hodgkin's lymphoma who have a CD4 T-cell count of less than 200 per microliter of blood and/or those who are not taking antiretroviral therapy usually do worse than those who have these factors present.

It appears that the best treatment for AIDS-associated non-Hodgkin's lymphoma is to use drugs that are used for HIV-negative patients. At one time, treatment consisted of low doses of chemotherapy. But with the advent of HAART, many patients can receive standard combinations of drugs used for chemotherapy in people who do not have AIDS. The use of hematopoietic (hematopoietic) factors in combination with chemotherapy has also shown promising results in the treatment of HIV-infected patients.

For patients with primary CNS lymphoma, chemotherapy or whole-brain radiation may be used. HAART is used to improve immune system function and prolong life.

Precancerous changes of the cervix and invasive cervical cancer

HIV-infected women are at increased risk of developing cervical intraepithelial neoplasia (CIN). HCN is the growth of abnormal, precancerous cells in the cervix or lower part of the uterus. Over time, cervical cancer can develop into invasive cervical cancer, in which cancer cells invade the deeper layers of the cervix (and can eventually spread throughout the body).

CNCM must be treated promptly (by removing or destroying the outer layers of cervical cells) to prevent it from developing into invasive cancer. Studies have shown that untreated cervical neoplasia is more likely to develop into invasive cancer in HIV-infected women than in healthy women. Standard treatment for HNSHL works less well in HIV-infected women. The chances of the disease returning (relapse) after treatment are quite high, which is associated with the function of the female immune system. Women with a CD4 cell count of less than 50 per microliter of blood have a high chance of recurrent cervical cancer.

HIV-infected women with invasive cervical cancer and good immune function usually do well with surgery and receive the same treatment as HIV-negative women. For patients with an advanced form of the disease, radiation itself does not help much. Women with advanced or recurrent cervical cancer receive chemotherapy. After completing the course of treatment, patients must be constantly monitored by a doctor to ensure that the disease does not recur. During cancer treatment, the patient's immune status must be constantly monitored and she must take antiretroviral drugs. These medications are commonly prescribed to improve treatment outcomes for invasive cervical cancer in HIV-infected women, regardless of CD4 cell count.

Women with AIDS and cervical cancer at the same time are not cured of cancer as successfully as HIV-negative patients. Women with a CD4 cell count of more than 500 tend to recover faster.

Oncological diseases not related to AIDS

Along with the widespread use of antiretroviral treatment, AIDS-related cancers are becoming less common. However, as HIV-infected people live longer, they have begun to develop cancers that are not always caused directly by HIV, such as lung, larynx, liver, colon and anal cancer, as well as Hodgkin's disease and multiple myeloma. In most cases, treatment includes antiretroviral drugs and the usual cancer treatments given to people without HIV. Any necessary HIV medications (such as antibiotics to prevent infection) are used at the same time.