AIDS malignancies have been recognized as a major complication of the HIV disease course, and the high mortality rate in AIDS patients is in part due to this complication. A number of factors have been implicated to be playing a role in the increase incidence of malignancies in AIDS patients. These factors include immunosuppression and a deficient immune surveillance by T cells in eliminating the transformed cells; viral cofactors such as EBV and KSHV have also been associated with malignant transformation of the infected cells. The prognosis of ARL in HIV-infected individuals was extremely poor prior to the HAART era, but the advent of HAART, there was a dramatic improvement in the prognosis of ARL in these patients.The survival rate has improved, especially for those ARL that were found to be associated with herpesviruses such as EBV and KSHV There were a substantial decrease in the number of cases of KS and NHL, in association with HAART, and the decrease in incidence appear to be independent of CD4 counts, substantiating the notion that coinfecting viruses may be playing a role in the disease. Most newly diagnosed cases of KS are patients that are either drug naïve or have virological failure upon treatment. In spite of the improvement in prognosis, HAART alone is inadequate for the majority of the antiviral naïve patients. A combination of HAART and conventional chemotherapy appears to be most effective. Moreover, the positive effects of HAART on some ARL and KS are not consistently observed for HPV-associated malignancies, including cervical and anal cancers.
Given the prolong survival rate of HIV-infected individuals with HAART, it is likely that ARL will continue to pose a challenge in the AIDS epidemic. HAART treatment, even though appears to be effective, still only leads to partial immune reconstitution. Prolonged immunosuppression is likely to lead to a resurgence of AIDS-associated cancers. In addition, HAART is still not widely available in parts of the world where AIDS has the greatest impact, such as the African continent. It is expected that AIDS-associated cancers will continue to pose a major challenge in the population for quite a while. Thus, more understanding on the role of oncogenic viral cofactor in the disease will be of great significance. ARL represents an intersection of virology, immunology, and tumor biology. A better understanding of the disease, the immune response, will provide useful information for the development of novel therapy and provide insights into cancer biology beyond the AIDS epidemic.
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