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29 - Neoplastic disease in pediatric HIV infection

Published online by Cambridge University Press:  23 December 2009

By
Richard F. Little
Edited by
Steven L. Zeichner  and
Jennifer S. Read
Richard F. Little
Affiliation:
HIV and acquired immune deficiency syndrome Malignancy Branch, CCR, NCI, National Institutes of Health, Bethesda, MD
Steven L. Zeichner
Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read
Affiliation:
National Institutes of Health, Bethesda, Maryland
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Summary

Introduction

HIV-infected patients have an increased incidence of malignancies. Three malignancies constitute AIDS-defining diagnoses: Kaposi's sarcoma (KS), non-Hodgkin's lymphoma (NHL), and cervical cancer. There are increased risks for other cancers [1]. Approximately 40% of HIV-infected adults develop cancer [2]. The neoplastic disease risk in HIV-infected children exceeds that of adults, but because of low background incidence, cancers are uncommon in children living in the West. In certain parts of Africa, pediatric neoplastic disease may be more common [3].

Epidemiology of AIDS-related cancers

Kaposi's sarcoma (KS)

In the USA KS primarily affects men who have sex with other men (MSM), and their female partners [4]. In sub-Saharan Africa, it is common among heterosexuals and children [5]. Greater understanding of human herpesvirus 8 (HHV-8) also termed Kaposi's sarcoma-associated herpesvirus (KSHV), helps to explain KS geographic variation [6, 7]. KSHV is a necessary, though insufficient, component in KS etiology.

Approximately 50% of adults infected with HIV and KSHV develop KS within 10 years [8]. Those infected with KSHV before HIV infection have lower risks of KS than those already infected with HIV before KSHV [9]. KSHV may be transmitted sexually and from mother to infant [10]. In Africa, HIV-associated KS is seen in adults and children [11]. Males develop KS more frequently than females. KSHV seroprevalence varies substantially in different regions and in different populations, tracking KS epidemiology.

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Chapter
Information
Handbook of Pediatric HIV Care , pp. 637 - 650
Publisher: Cambridge University Press
Print publication year: 2006

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