AIDS-Related Cancers and Their Treatment PDF

Preface

Malignancies are a significant cause of illness and death in the population infected with the human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS). As the management of retroviral disease and opportunistic infections improves, allowing patients to survive longer with severe immunocompromise, these individuals will increasingly come to the attention of the practicing oncologist. A multidisciplinary approach is essential for developing the appropriate therapeutic management options. This approach must utilize the expertise of oncologists, internists, infectious disease specialists, and other subspecialists. Furthermore, this approach will be enhanced by an understanding of the epidemiology, biology, immunology, virology, and pathogenesis of malignancy and the underlying HIV infection.

People with HIV/AIDS are at risk for three AIDS-defining malignancies: Kaposi's sarcoma, intermediate or high-grade B cell/non–Hodgkin's lymphoma, and cervical cancer. In addition, anogenital neoplasias and Hodgkin's disease are increasingly noted. With nearly 1 million adults with HIV infection in the United States the co-incidence of HIV and common cancers will rise. Diagnosis and treatment of AIDS-specific malignancies, as well as the common cancers, pose unique and special challenges in a setting where the underlying illness, HIV infection, has significantly destroyed the patient's immunity.

The book begins with a general introduction of the epidemiology of AIDS and AIDS malignancies, and then delves into the diagnosis and management of malignancies by signs and symptoms, based on the regional anatomy. A specific chapter describes cancer in children with HIV/AIDS. The many therapeutic challenges encountered in the AIDS population are addressed. Non–AIDS-defining cancers present unique problems in differential diagnosis and in clinical management of the patient who also has HIV/AIDS. Separate chapters outline future directions for prevention and therapy, summarizing approaches and agents currently being evaluated or envisioned.

Critical patient management and treatment decisions must address the underlying HIV-related immunosuppression and its related complications. For this reason the book includes comprehensive chapters on agents and approaches to attenuate side effects of therapy. The need for combining primary anti-HIV therapy with antitumor therapy is presented, along with ways to measure the effects of such therapy. Infections are a complication of HIV, and can increase with the use of antitumor agents that further exacerbate an already compromised immune system. A chapter focused on the management of infection in the AIDS patient with cancer is discussed. Separate chapters provide guidance in dealing with the psychological and social aspects of HIV infection, both for the individual patient and for the communities of urban poor, homosexuals, and drug users. The last chapter summarizes the National Cancer Institute's programs in AIDS and cancer research and provides patient and health care workers with website addresses for clinical trials information and research resources.

The book is designed to be comprehensive in scope, but focuses on clinical management issues that are of practical use to the health care provider involved with the care of patients with AIDS malignancies. This information is concisely but clearly presented, with ample tables, illustrations, and photographs. It should be of immediate use to practicing oncologists, general internists, infectious disease specialists, surgeons, radiologists, and other health care providers.