title: The evolving scenario of non-AIDS-defining cancers: challenges and opportunities of care.
abstract: BACKGROUND
  The impact of highly active antiretroviral therapies (HAART) on the risk of non-AIDS-defining cancers (NADCs) and the role of biological and clinical factors in their pathogenesis are debated issues. The purpose of this review is to examine the epidemiology, etiology, and not-yet-defined pathogenic characteristics of NADCs and discuss topics such as treatment strategies, comorbidity, and multidrug interactions. Four types of NADCs that deserve special attention are examined: anal cancer, Hodgkin lymphoma (HL), hepatocellular carcinoma, and lung cancer.
  
  
  METHODS
  The PubMed database and the Cochrane Library were searched by focusing on NADCs and on the association among NADCs, HAART, aging, and/or chronic inflammation. All articles were reviewed to identify those reporting variables of interest.
  
  
  RESULTS
  NADC incidence is twofold higher in patients with HIV/AIDS than in the corresponding general population, and this elevated risk persists despite the use of HAART. The mechanisms that HIV may use to promote the development of NADCs are presently unclear; immunological mechanisms, either immunodeficiency and/or immunoactivation, may play a role.
  
  
  CONCLUSIONS
  Recent clinical studies have suggested that equivalent antineoplastic treatment is feasible and outcome can be similar in HIV-infected patients on HAART compared with uninfected patients for the treatment of HL and anal and lung cancers. However, patients with advanced HIV disease and/or aging-related comorbidities are likely to experience worse outcomes and have poorer tolerance of therapy compared with those with less advanced HIV disease.
authors: Division of Medical Oncology, Unit of Epidemiology and Biostatistics, Division of Pathology, Scientific Directorate, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy.
authors: Emanuela
authors: E
authors: Vaccher
authors: Division of Medical Oncology, Unit of Epidemiology and Biostatistics, Division of Pathology, Scientific Directorate, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy.
authors: Diego
authors: D
authors: Serraino
authors: Division of Medical Oncology, Unit of Epidemiology and Biostatistics, Division of Pathology, Scientific Directorate, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy.
authors: Antonino
authors: A
authors: Carbone
authors: Division of Medical Oncology, Unit of Epidemiology and Biostatistics, Division of Pathology, Scientific Directorate, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy dirscienti@cro.it.
authors: Paolo
authors: P
authors: De Paoli
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006689:Hodgkin Disease / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D012307:Risk Factors
keywords: Chemotherapy; HIV; Immunodeficiency; Non-AIDS-defining cancers