HIV and childhood cancer

Abstract

HIV infection has had a profound impact on childhood cancer. HIV-related immunosuppression increases the incidence of certain forms of cancer, and HIV infection and its co-morbidities such as TB have made it more difficult to treat incidental malignancies. The HIV-related malignancies include AIDS-defining cancers (Kaposi Sarcoma and B-cell lymphomas including primary central nervous system lymphoma) and HIV-associated neoplasms (Leiomyosarcoma and mixed-cellularity Hodgkin’s Lymphoma). This review aims to encourage early detection of and appropriate decision-making for HIV-positive children with cancer in a general practice or paediatric office setting and presents data to support the following conclusions. There is an increased rate of Kaposi sarcoma and B-cell non-Hodgkin Lymphoma in HIV-infected children. Maintain a high index of suspicion and discuss your concerns with a paediatric oncologist. Children with malignancy can have excellent outcomes when treated early with antiretroviral therapy. Consequently, all children with malignancy should have their HIV status determined. A diagnosis of Kaposi sarcoma, Diffuse Large B-cell lymphoma and primary central nervous system lymphoma in particular should make one think of HIV infection. HIV-infected children with suspected malignancy should be referred to a paediatric oncology centre as soon as possible. Start antiretrovirals in therapy-naïve children if you anticipate any delay in transfer. Rule out and treat TB in HIV-infected children with suspected malignancy; a diagnosis of malignancy doesn’t preclude the diagnosis of TB. Initiate anti-TB medication immediately if TB is diagnosed.