Most Likely AIDS-Defining Malignancy in a 40-Year-Old HIV-Positive Woman
Non-Hodgkin lymphoma (NHL) is the most likely AIDS-defining malignancy in this patient, representing 21% of all cancers in people living with HIV, making it the single most common AIDS-defining cancer overall. 1, 2
Epidemiology of AIDS-Defining Malignancies
The three AIDS-defining malignancies are:
- Non-Hodgkin lymphoma (NHL): 21% of all HIV-associated cancers 1, 2
- Kaposi sarcoma (KS): 12% of all HIV-associated cancers 1, 2
- Invasive cervical cancer: Only 1% of all HIV-associated cancers in the United States 1, 2
Why NHL is Most Likely
NHL accounts for approximately one in five cancers diagnosed in people living with HIV, making it statistically the most probable AIDS-defining malignancy regardless of sex. 1, 2 The tumor is driven by persistent immune deficiency and often associated with Epstein-Barr virus (EBV) infection. 1
Gender-Specific Considerations
While cervical cancer is unique to women and carries a 3- to 5-fold increased risk in HIV-positive women compared to HIV-negative women 1, 2, it represents only 1% of cancers in the U.S. HIV population. 1, 2 This low percentage reflects effective cervical cancer screening programs and the predominantly male composition of the U.S. HIV cohort. 1, 2
In contrast, NHL affects both sexes equally and occurs at much higher absolute frequency, making it the more likely diagnosis even in a female patient. 1, 2
Kaposi Sarcoma as Alternative
KS accounts for 12% of HIV-associated cancers and is driven by human herpesvirus-8 (HHV-8) infection in the setting of immunosuppression. 1, 2 Although KS incidence has declined by 90% with antiretroviral therapy (ART), people living with HIV remain at substantially elevated risk compared to the general population. 1
Clinical Pitfalls to Avoid
Do not assume cervical cancer is most likely simply because the patient is female—the absolute incidence data clearly shows NHL predominates. 1, 2 Cervical cancer screening has dramatically reduced its prevalence in the U.S. HIV population, whereas NHL remains common despite effective ART. 1, 2
When evaluating lymphadenopathy in any HIV-positive patient, biopsy suspicious or PET-avid nodes liberally to differentiate NHL from non-malignant causes such as opportunistic infections. 1, 2 This is particularly critical in people living with HIV, where reactive adenopathy from infection is common. 1, 2
Management Principles
Regardless of which AIDS-defining malignancy is ultimately diagnosed, the patient should be co-managed by an oncologist and HIV specialist, with ART continued throughout cancer treatment. 1, 2 Cancer therapy should follow standard NCCN guidelines without HIV-specific modifications based solely on HIV status. 1, 2