A patient with a 12-year history characterized by four non-AIDS-related malignancies, occurring before and after the disclosure of HIV infection

Excerpt

Notwithstanding the introduction of combination antiretroviral therapy (cART) since 20 years, both HIV-related and HIV-unrelated malignancies continue to occur, in patients aware of their HIV disease, and in subjects with a missed-delayed diagnosis of HIV infection. The pathogenesis of this phenomenon has been attributed to a persisting imbalance of the cancer immune control despite a quantitative recovery of T-lymphocyte count achieved during cART, to concurrent oncogenic infections (including HIV itself), to lifestyle habits, and also to the cART and HIV itself, which induce a premature ageing which sums to the increasing mean age of HIV-infected population during the cART era. These malignancies may occur as presenting diseases in patients with a newly diagnosed HIV infection, or may be diagnosed concurrently with other HIV-related and HIV-unrelated illnesses. They often show an atypical presentation and course, making both differential diagnosis and clinical management cumbersome. The risk of developing a cancer increases in relation to the duration of underlying HIV disease since childhood [1], non-AIDS-defining malignancies are steadily on the rise compared with AIDS-defining ones, and finally some clinically silent or masked malignancies may be retrieved only at necropsy [2, 3]. For instance, the thyroid may represent a secondary, occult target of the majority of HIV-related opportunistic and neoplastic disorders, due to Mycobacterium tuberculosis, Mycobacterium avium-intracellulare, other bacteria, Cryptococcus neoformans, Pneumocystis jroveci and other fungi, Cytomegalovirus, and Kaposi’ sarcoma. In a Brazilian necropsy series focusing on thyroid involvement during HIV infection, four cases of incidental, well differentiated thyroid papillary carcinoma were found [2]. …