HIV and malignancies

Question 1

AIDS

Answer 1

HIV related encephalopathy
Cytomegalovirus retinitis
Pneumocystic Jiroveci
Chronic intestinal 
Cryptosporidiosis
Invasive Cervical Cancer

Question 2

HIV structure

Answer 2

two copies of RNA

nucleoproteins which include reverse transcriptase, protease and integrase

Question 3

AIDS-defining cancers

Answer 3

Kaposi sarcoma (cutaenous, mucosal)
High-grade B cell non-Hodgkin lymphoma
Invasive cervical cancer

Question 4

Karposi sarcoma

Answer 4

HHV-8
purple nodules lesions
cutaneous and mucosal lesion
visceral disease is uncommon
management: ART, localised therapy (radiotherapy, intralesional chemo, systemic chemotherapy)

Question 5

non-hodgkin’s lymphoma

Answer 5

EBV
diffuse B cell lymphoma (DLBCL) and Burkitt lymphoma
advanced clinical stage, B symptoms, extranodol involvement
CNS involvement

management: ART + standard chemotherapy as per HIV -ve and intrathecal therapy

Question 6

primary CNS lymphoma

Answer 6

confined to the craniospinal axis
advanced and prolonged immunosuppression

median survival is 48 days

presents with focal neurological lesions

diagnosis: MRI and stereotactic brain biopsy (EBV pos) post 2 week trial of toxoplasma treatment
management: ART and high dose methotrexate (+/- cytarabine) where high performance or palliative radiotherapy.

Question 7

cervical cancer

Answer 7

up to a x5 fold increase
HPV 16/18 progresses quicker
presents at a younger age

mx: ART and standard treatment as per HIV negaitve popualtion

all HIV positive women should have an annual smear test

Question 8

anal cancer

Answer 8

incidence x40 higher
younger age, MSM
pathogenesis similar to cervical cancer

rectal bleeding, pain, incontinence, asymptomatic

a high index of suspicion to avoid late diagnosis

ART + chemoradiotherapy
5-year survival increase

Question 9

hepatocellular carcinoma

Answer 9

co-infection hep C

hep B exposure and malignancy risk

Question 10

PREP

Answer 10

truvada- combination tablet of NRTI’s