Epidemiology of AIDS-Associated Malignances

The evidence for an increased risk of Kaposi’s sarcoma and non-Hodgkin’s lymphoma in HIV-infected people is consistent and in fact KS and NHL (chiefly immunoblastic, Burkitt’s lymphoma, and primary lymphoma of the brain) have, since the early days of the epidemic, been among the so-called «AIDS-defining illnesses». Several additional tumours appear to be associated with HIV infection, albeit with smaller relative and absolute risks. The evidence is strongest for associations of HIV with invasive cervical cancer (ICC), Hodgkin’s diseases, anogenital neoplasia, testicular seminoma, paediatric leiomyosarcoma and conjunctival cancer. Since the mid-1990’s several epidemiologic studies have led to a better quantification of the burden of malignancies in HIV-infected populations. Different ways of quantifying the higher risk of cancer in persons with AIDS have been tried. Population-based cancer registration data first yielded indirect estimates of HIV-associated cancer, based on surrogate indicators of groups at risk for HIV infection. Cohort studies of HIV-seropositive individuals often provide detailed information of risk-correlates and follow-up but often they were based on too few cancer cases to provide robust RR estimates. The purpose of this review is to summarise and describe the epidemiological findings on malignancies associated with HIV infection and/or AIDS, taking into account the strengths and weaknesses of different study designs.