Non-AIDS-defining cancers among HIV-infected people

The natural history of HIV infection has been greatly changed by the introductionof highly active antiretroviral therapy (HAART). As a consequence of improvedimmune function, the incidence of AIDS-defining cancers (ADCs), such as Kaposi's sarcoma, non-Hodgkin's lymphoma (NHL) and invasive cervical cancer, hassignificantly declined. On the contrary, non-AIDS-defining cancers (NADCs), such as hepatocellular carcinoma, anal cancer, lung cancer, colorectal cancer andHodgkin's lymphoma, have gradually emerged as a major fraction of the overallcancer burden. The reasons are still partially unknown. Some of the increasedrisk may be explained by a high prevalence of cancer risk factors, such assmoking, alcohol consumption, human papilloma virus (HPV) infection and HCVinfection among HIV-infected people. The role of immunosuppression in thedevelopment of NADCs is controversial, as several studies have not found aclear-cut evidence of an association between the degree of immunosuppression and the development of NADCs. Analogously, the impact of HAART is still not welldefined. Future research should focus on the etiology of NADCs, in order to shed light on the pathogenesis of cancer and ultimately to work for prevention;moreover, additional studies should evaluate the best therapeutic approaches toNADCs and the impact of cancer screening interventions among HIV-infected people,in an effort to diagnose cancer at an earlier stage.