AIDS-defining and non-AIDS-defining malignancies: cancer occurrence in the antiretroviral therapy era

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Abstract
Effective antiretroviral therapy use has resulted in a large number of older individuals living with HIV. Recent literature is reviewed with respect to the incidence and risk factors for cancer in HIV patients. Previous studies have demonstrated substantial declines in AIDS-defining malignancies in the era of antiretroviral therapy, with clear links to better immune function. Increases in non-AIDS-defining malignancies such as Hodgkin's disease, skin, lung, anal, and kidney cancers have been noted by some but not all authors. Certain non-AIDS-defining malignancies may be related to immunodeficiency, although data are conflicting. Recent studies have indicated that confounding by traditional risk factors, including cigarette use, may account for some of the increased risk of lung and other cancers in HIV patients. Non-AIDS-defining malignancies account for more morbidity and mortality than AIDS-defining malignancies in the antiretroviral therapy era. Traditional risk factors play a significant role in the increased risk of non-AIDS-defining malignancies for HIV-infected individuals, but do not entirely explain the excess cancer risk. Unanswered questions remain including the relationship of immunodeficiency and the risk of site-specific non-AIDS-defining malignancies, and the effect of antiretroviral therapy duration and drug class on cancer risk.