Current research and the future

The rapidly increasing evidence on viral involvement in AIDS-associated malignancies suggests novel molecular targets for drug discovery using drug screening and molecular modelling. Vaccines for cancers occurring in patients with human papilloma viruses associated with cervical and ano-genital carcinoma and EBV in haematological malignancies are currently being researched. Other therapeutic approaches include biological therapy (for example IL-2, IL-12, IFN-a), immune-based therapy (for example antigen-presenting cells and monoclonal antibodies against B-cell targets) and angiogenesis inhibitors.

New assays to detect KSHV are now in use. Further work is needed on the cofactors influencing the progression of KSHV seropositive individuals to the development of KS. The antiherpes drug cidofovir has activity against KSHV but it remains to be seen as to whether it is an effective treatment for KS.

To improve existing treatments the effects on the underlying HIV infection and the impact on the immune system of anti-tumour therapy need to be identified. As anti-HIV therapies have a clinical effect on tumour incidence, complex issues of drug—drug interactions and overlapping toxicities must be considered.

In the HAART era NHL is likely to become the most common malignancy associated with AIDS — new treatment strategies are urgently needed as treatment is currently extremely disappointing. Possibilities include the exploitation of cytokine networks, as we already know that these patients have low levels of IL-2 and IFN-7 but elevated IL-6. Treatment with low-dose IL-2 is already undergoing trials.

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