Revista de SIDA e investigación clínica

The Challenge of Malignancies in HIV-1, Beyond Immune Activation and Back to Decreased Immune Surveillance

Abstract

Daniel O Griffin

The HIV-1 epidemic continues around the world, but also in the United States where we continue to see approximately 50,000 new diagnosis of HIV-1 infection each year. It is estimated that there are currently more than 1.2 million individuals in the United States living with HIV-1 infection, with 12.8% unaware of their infection. Effective therapy for HIV-1 is allowing infected individuals to have greater life expectancies. We now have an older aging population infected with HIV-1, reaching ages where diseases such as malignancy are increased in incidence. Even compared to age matched peers there is clearly an excess of malignancies affecting the HIV-1-infected population. Malignancies are now the most common cause of death for patients in the United States living with HIV-1 infection. B-cell malignancies are the most common malignancy accounting for death in HIV-1 infected patients in the United States. It is not clear that all that we have come to understand regarding B-cell lymphomas applies to the lymphomas developing in the HIV-1-infected population. It is particularly important to understand the factors leading to and molecular disturbances involved in these lymphomas developing in the HIV-1-infected population as they appear to be increasing in frequency and characterized by aggressive courses with short median survival times. Although much attention has focused on the chronic immune activation hypothesis of cancer in HIV-1 infection, this article explores the possible contribution of decreased immune surveillance and exposure to highly active antiretroviral medications to the development of B-cell lymphomas in HIV-1-infected patients.