SUMMARY
The prevalence of HIV in the United States continues to rise as a result of the combined effects of a declining HIV death rate, and a sustained rate of new infections. Furthermore, HIV-infected patients on antiretroviral therapy can expect to live nearly as long as uninfected persons (within 5 years) providing ample time for individuals to develop AIDS-associated and non–AIDS-associated hematologic and oncologic conditions. HIV-infected individuals remain at increased risk of AIDS-defining malignancies such as Kaposi sarcoma, aggressive non-Hodgkin lymphoma, primary central nervous system lymphoma, and invasive cervical cancer and a number of non–AIDS-defining malignancies, including Hodgkin lymphoma, as well as anemia and thrombocytopenia. When individuals present with any of these hematologic or malignant illnesses it should be the standard of care to obtain HIV testing so as to provide optimal treatment to both the presenting illness and the HIV.
Acronyms and Abbreviations
ABVD, Adriamycin, bleomycin, vinblastine, dacarbazine; ADAMTS 13, a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13; AMC, AIDS Malignancy Consortium; ART, antiretroviral therapy; AVD, Adriamycin, vinblastine, dacarbazine; BEACOPP, bleomycin, etoposide, Adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone; BFU-E, burst-forming unit–erythroid; CFU-GM, granulocyte-macrophage colony-forming unit; CFU-GEMM, granulocyte-erythrocyte-monocyte and megakaryocyte colony-forming unit; CHOP, cyclophosphamide, doxorubicin, vincristine, prednisone; CHORUS, Collaboration in HIV Outcomes Research/U.S. study; CMV, cytomegalovirus; CODOX-M/IVAC, cyclophosphamide, vincristine, doxorubicin, methotrexate/ifosfamide, mesna, etoposide, cytarabine; CRF, circulating recombinant form; CSF, cerebrospinal fluid; CTL, cytotoxic T-lymphocyte; DHHS, Department of Health and Human Services; EBV, Epstein-Barr virus; ECOG, Eastern Cooperative Oncology Group; EPOCH, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin; ESHAP, etoposide, methylprednisolone, high-dose cytarabine, cisplatin; G6PD, glucose-6-phosphate dehydrogenase; HHV8, human herpesvirus-8; HPV, human papillomavirus; HSV, herpes simplex virus; HUS, hemolytic-uremic syndrome; hyperCVAD, cyclophosphamide, vincristine, doxorubicin, dexamethasone; IL, interleukin; IRIS, immune reconstitution inflammatory syndrome; ITP, idiopathic thrombocytopenic purpura; KICS, KSHV-associated inflammatory cytokine syndrome; KSHV, Kaposi sarcoma-associated herpesvirus; LDH, lactate dehydrogenase; LPS, lipopolysaccharide; MRI, magnetic resonance imaging; NHL, non-Hodgkin lymphoma; nnRTI, nonnucleoside reverse transcriptase inhibitor; nRTI, nucleoside reverse transcriptase inhibitor; PCR, polymerase chain reaction; PET-CT, positron emission tomography–computed tomography; PrEP, preexposure prophylaxis; R-CHOP, rituximab plus CHOP; R-EPOCH, rituximab plus EPOCH; R-ICE, rituximab plus ifosfamide, carboplatin, etoposide; SEER, Surveillance, Epidemiology, and End Results Program; SIV, simian immunodeficiency virus; TTP, thrombotic thrombocytopenic purpura.
HIV, the virus that causes AIDS, is a lentivirus that originated as a simian immunodeficiency virus (SIV) in chimpanzees and entered the human population in the early 20th century in equatorial Africa.1,2 First isolated in 1983,3,4 HIV-1 actually comprises four distinct viruses (types M, N, O, and P) that represent four separate transmission events that occurred between chimpanzees and humans, likely the result of predation of monkeys by humans and mucosal or nonintact skin contact with infected fluids. Group M, the viral type responsible for the HIV-1 pandemic, was detected in a tissue sample from 1959 and probably entered the human population in or around Kinshasa, Democratic Republic of Congo (then Leopoldville, Belgium ...