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HIV-related and non-HIV-related &#40;some of which are related to other viral diseases&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">8&#8211;16</span></a> The HIV-related malignancies include 1&#41; Kaposi&#39;s sarcoma&#44; related to the human herpesvirus type 8 virus &#40;HHV-8&#41;&#59; 2&#41; non-Hodgkin&#39;s lymphomas&#44; related to the Epstein Barr virus &#40;EBV&#41;&#59; and 3&#41; cervical carcinoma&#44; related to the human papilloma virus &#40;HPV&#41;&#46; The tumor diseases independent of HIV infection and related to viral diseases include Hodgkin&#39;s lymphoma &#40;HL&#41;&#44; related to EBV&#59; anal canal carcinoma&#44; related to HPV&#59; and hepatocarcinoma&#44; associated with the hepatitis <span class="elsevierStyleSmallCaps">C</span> &#40;HCV&#41; and B &#40;HBV&#41; viruses&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">17</span></a> Shepherd et al&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">18</span></a> proposed that the classification of malignancies be based on their relationship &#40;or lack thereof&#41; with viral infections&#46; Tumor diseases without viral involvement are represented mainly by lung carcinoma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We recently reviewed the tumor diseases in 4994 patients with HIV treated at our center from 1986 to 2016&#46; At least 1 tumor was diagnosed in 416 patients &#40;8&#46;3&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">19&#44;20</span></a> In our experience&#44; as the use of antiretroviral treatment &#40;ART&#41; has spread&#44; the incidence of AIDS-defining cancers &#40;ADCs&#41; has decreased&#44; while the incidence of NADCs has increased&#46;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">19&#44;20</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Etiopathogenesis</span><p id="par0020" class="elsevierStylePara elsevierViewall">The origin of tumor diseases in patients with HIV infection is multifactorial&#46; The most important factors are the HIV itself&#44; immunosuppression&#44; co-infection with oncogenic viruses and increased survival due to the use of ART&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">21&#8211;24</span></a> HIV is a necessary but not sufficient condition&#44; because it is not an oncogenic virus&#46; However&#44; the presence of HIV creates a condition of chronic immunosuppression&#44; which is related to ADCs&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">21&#44;25</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Immune impairment and uncontrolled HIV viremia increase the risk of developing malignancies&#44; such that an undetectable viral load and CD4&#43; lymphocyte counts greater than 500&#47;mm<span class="elsevierStyleSup">3</span> are factors that protect against the development of some tumors&#44; mainly ADCs&#46; However&#44; coinciding with the introduction of highly active ART regimens&#44; there has been an increase in NADCs because although the immunologic situation improves&#44; it is not completely restored&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">26&#8211;29</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The influence of ART on the onset of tumors is independent of the drug employed&#46; There are no differences between patients treated with regimens based on non-nucleoside reverse transcriptase inhibitors&#44; protease inhibitors and integrase inhibitors&#46;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">19&#44;20&#44;27&#8211;32</span></a> Moreover&#44; treatment interruptions&#44; which have been performed in the past&#44; increase the incidence of NADCs&#46; This outcome was established in the SMART study&#44; where all NARDs&#44; including NADCs&#44; were significantly more common in patients who had treatment interruptions than in those who continued the therapy uninterrupted&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">33</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Another important factor for the development of malignancies in patients with HIV infection is co-infection with other viruses&#44; particularly HPV&#44; which is related to cervical carcinoma&#44; anal canal carcinoma and otorhinolaryngological carcinoma&#46; Other oncogenic viruses include the previously mentioned hepatotropic viruses&#44; EBV and HHV-8&#46;<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">18&#44;34&#44;35</span></a> Ultimately&#44; the increase in survival is one of the factors that has most affected the increase in neoplastic diseases in this population&#46;<a class="elsevierStyleCrossRefs" href="#bib0575"><span class="elsevierStyleSup">36&#44;37</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Non-AIDS-defining cancers</span><p id="par0040" class="elsevierStylePara elsevierViewall">This group of malignancies is highly heterogeneous and varies by geographical area&#46; They generally appear in young patients and have an atypical presentation&#44; with large tumor masses that can quickly progress despite treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0585"><span class="elsevierStyleSup">38&#8211;42</span></a> The treatments do not differ from those used in the general population&#44; 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Other common tumors in the general population&#44; such as breast&#44; prostate and colon carcinoma&#44; do not have a higher incidence rate among patients with HIV&#44; and their evolutionary behavior is similar&#46;<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">25&#44;47</span></a> Nevertheless&#44; breast carcinoma is also less frequent among women with HIV but is usually more aggressive&#46;<a class="elsevierStyleCrossRefs" href="#bib0635"><span class="elsevierStyleSup">48&#44;49</span></a></p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Hodgkin&#39;s lymphoma</span><p id="par0050" class="elsevierStylePara elsevierViewall">HL is one of the most common NADCs and has an incidence rate between 15 and 30 times higher than that of the general population&#46; Patients with HL do not present significant immunosuppression&#46; In a number of series&#44; the incidence of LH was higher the greater the CD4&#43; lymphocyte count&#46;<a class="elsevierStyleCrossRefs" href="#bib0645"><span class="elsevierStyleSup">50&#44;51</span></a> To explain this finding&#44; it has been speculated that there is a possible relationship between Reed&#8211;Sternberg cells and the CD4&#43; lymphocytes that surround them&#46; In this respect&#44; Reed&#8211;Sternberg cells&#44; which produce cytokines&#44; attract nearby CD4&#43; and other inflammatory cells&#46; As a result&#44; these CD4&#43; cells are activated and send the necessary signals for the proliferation and survival of malignant cells&#44; which would be more pronounced in patients with higher CD4&#43; lymphocyte counts&#46;<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">52</span></a> In most cases&#44; HL in patients with HIV presents in stage IVB&#44; and the treatment does not differ from that used in HIV-negative patients&#46; As with any other type of tumor&#44; the use of ART and the prophylaxis of opportunistic infections are an essential part of the treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">3&#44;43&#44;53</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In patients with HIV infection&#44; HL survival is determined by the tumor-associated prognostic factors&#59; however&#44; ART has primary importance&#46; In a Spanish multicenter study&#44;<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">54</span></a> the overall survival of these patients at 10 years was 60&#37;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Hepatocarcinoma</span><p id="par0060" class="elsevierStylePara elsevierViewall">The incidence rate of hepatocarcinoma in the population with HIV infection is 8 times higher than that of the general population&#44; although its etiopathogenesis and evolutionary behavior do not differ significantly between the 2 populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0670"><span class="elsevierStyleSup">55&#8211;57</span></a> The factors involved in the development of hepatocarcinoma are chronic viral hepatitis &#40;especially hepatitis C in our community&#41;&#44; cirrhosis of any etiology and alcohol consumption&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The main and possibly only prevention measure is HCV treatment&#59; however&#44; risk reduction in patients with sustained response to antiviral treatment is not absolute&#46; We therefore need to continue using screening strategies even when the HCV infection has been cured&#46;<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">58</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Carcinoma of the anal canal</span><p id="par0070" class="elsevierStylePara elsevierViewall">Carcinoma of the anal canal is closely related to the oncogenic genotypes of HPV&#44; which is detected in more than 90&#37; of cases&#46; While the incidence rate of this carcinoma in the population with HIV infection is 55&#8211;144&#47;100&#44;000 patients&#47;year&#44; the rate in the general population is only 1&#8211;1&#46;5&#47;100&#44;000 patients&#47;year&#46;<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">59</span></a> Homosexual men are at greatest risk for this disease&#44; but it has been diagnosed in women who have anal sex and in patients with genital warts&#46;<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">59</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The main recommended preventive measures are the use of condoms &#40;although they do not provide protection in all cases&#41; and vaccination&#44; whose efficacy in preventing cervical carcinoma has already been proven&#46;<a class="elsevierStyleCrossRefs" href="#bib0695"><span class="elsevierStyleSup">60&#44;61</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">According to the recommendations of the AIDS workgroup &#40;GESIDA&#41; of the Spanish Society of Infectious Diseases and Clinical Microbiology&#44; anal cytology should be performed for the early diagnosis of at-risk patients&#44; regardless of the presence or absence of HPV &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Lung carcinoma</span><p id="par0085" class="elsevierStylePara elsevierViewall">Lung carcinoma is the most common tumor&#44; both in the population with HIV infection and the general population&#44; and has a close relationship with tobacco use&#46; However&#44; in patients with HIV infection&#44; regardless of their smoking habit&#44; lung carcinoma has been observed to be 2&#8211;4 times more common&#44; occurring at younger ages&#44; with a more aggressive behavior and a poorer prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0705"><span class="elsevierStyleSup">62&#8211;65</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Lung cancer is one of the main causes of death&#46; Until recently&#44; however&#44; there has been no screening method that enabled an early diagnosis&#46; Based on the published data of the National Lung Screening Trial in 2013&#44;<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">66</span></a> the current proposal is to use low-radiation computed tomography for the at-risk population without HIV&#44; because it has been shown to be useful in the early diagnosis of this tumor&#44; although its cost-effectiveness is still being evaluated&#46; In the population with HIV infection&#44; this aspect has been scarcely studied&#46; GESIDA has therefore conducted a multicenter study to assess the efficacy of this measure &#40;GESIDA 8815&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0730"><span class="elsevierStyleSup">67</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Treatment of non-AIDS-defining cancers</span><p id="par0095" class="elsevierStylePara elsevierViewall">Treatment of NADCs&#44; as with ADCs&#44; is based on 3 fundamental pillars<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">44&#44;68&#8211;70</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Antineoplastic treatment should be the same as that used for HIV&#8722; patients&#46; If this premise is not considered&#44; the mortality can increase because inappropriate therapies will be performed&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">71</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Treatment of the HIV infection with an effective and safe &#40;without drug interactions&#41; ART should be started early&#46;<a class="elsevierStyleCrossRefs" href="#bib0755"><span class="elsevierStyleSup">72&#8211;74</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Prophylaxis and treatment of opportunistic infections is an essential measure and should be performed for infections directly related to the immunosuppression and for those infections &#40;such as tuberculosis&#41; that have a high incidence rate in the community&#46; After employing chemotherapy or radiation therapy&#44; the total CD4&#43; lymphocyte count will be reduced by 30&#8211;50&#37; compared with baseline&#46; Regaining pretreatment levels will take more than 6&#8211;12 months&#46;<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">75</span></a> Always performing prophylaxis with cotrimoxazole is therefore recommended&#44; even if at the start of treatment the CD4&#43; lymphocyte counts are greater than 200&#47;mm<span class="elsevierStyleSup">3</span>&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Early diagnosis and prevention</span><p id="par0115" class="elsevierStylePara elsevierViewall">With regard to the measures aimed at the early diagnosis of malignancies&#44; none of the ART guidelines &#40;except those of the European AIDS Clinical Society<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">76</span></a>&#41; expressly mention this point&#46; In Spain&#44; GESIDA has prepared a document &#40;drafted independently from the ART guidelines&#41; on managing NADCs&#44; covering both prevention and early diagnosis&#44; which basically does not differ from the recommendations for the general population &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a> According to the recommendations&#44; the most important preventive measures with proven efficacy are developing healthy life habits &#40;reducing alcohol and tobacco consumption&#41;&#44; HCV treatment and the use of vaccines against HPV and&#44; to a lesser extent&#44; HBV&#46;<a class="elsevierStyleCrossRefs" href="#bib0610"><span class="elsevierStyleSup">43&#44;57&#44;58&#44;60&#44;61&#44;77&#8211;79</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusions</span><p id="par0120" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#46;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Most malignancies &#40;ADCs and NADCs&#41; that appear in patients with HIV infection are related to viral infections&#46; NADCs have a higher frequency and greater severity than ADCs&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#46;</span><p id="par0130" class="elsevierStylePara elsevierViewall">An undetectable viral load &#40;HIV&#41; and CD4&#43; lymphocyte counts higher than 500&#47;mm<span class="elsevierStyleSup">3</span> are factors that protect against the development of some tumors&#44; mainly ADCs&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#46;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Treatment for malignancies in patients with HIV resembles that used in the general population&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4&#46;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Prophylaxis of opportunistic infections should be employed while administering chemotherapy&#44; even when CD4 counts are higher than 200&#47;mm<span class="elsevierStyleSup">3</span>&#46;</p></li></ul></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Hepatocarcinoma"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Since the start of the human immunodeficiency virus &#40;HIV&#41; epidemic&#44; tumor disease among patients has been significant&#46; The collection of malignancies can be divided primarily into 2 groups&#58; those associated with HIV &#40;all of which are related to viral diseases&#41; and those not associated with HIV &#40;only some of which are associated with viral diseases&#41;&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The origin of these malignancies is multifactorial&#44; and the main causes that have led to an increase in tumor disease are immunosuppression&#44; coinfection with oncogenic viruses and life prolongation secondary to the use of antiretroviral therapy&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Establishing the general characteristics of the undiagnosed AIDS tumors is difficult&#44; mainly because they are a highly heterogeneous group formed by malignancies of a diverse nature&#46; The treatments do not differ from those used in the general population&#44; although the management can be more difficult due to the late diagnosis&#44; drug interactions and associated comorbidities&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Desde los inicios de la epidemia del virus de la inmunodeficiencia humana &#40;VIH&#41;&#44; la patolog&#237;a tumoral ha sido muy importante&#46; El conjunto de las neoplasias se puede dividir b&#225;sicamente en 2 grupos&#58; las asociadas al VIH&#44; todas ellas relacionadas con enfermedades virales&#44; y las no asociadas al VIH&#44; entre las que algunas est&#225;n asociadas a enfermedades virales y otras no&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El origen es multifactorial y las principales causas que han llevado a que se produzca un aumento de la patolog&#237;a tumoral son la inmunodepresi&#243;n&#44; la coinfecci&#243;n con virus oncog&#233;nicos y la prolongaci&#243;n de la vida secundaria al uso de tratamiento antirretroviral&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Establecer las caracter&#237;sticas generales de los tumores no diagn&#243;sticos de sida es dif&#237;cil fundamentalmente porque son un grupo muy heterog&#233;neo formado por neoplasias de diversa &#237;ndole&#46; Los tratamientos no difieren de los empleados en la poblaci&#243;n general&#44; aunque el manejo puede ser m&#225;s dif&#237;cil por el diagn&#243;stico tard&#237;o&#44; las interacciones medicamentosas y las comorbilidades asociadas&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Valencia Ortega ME&#46; Neoplasias e infecci&#243;n por el virus de la inmunodeficiencia humana&#58; &#191;enfermedades emergentes&#63;&#46; Rev Clin Esp&#46; 2018&#59;218&#58;149&#8211;155&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Classification of the main malignancies presented by patients with human immunodeficiency virus infection&#46; Malignancies related to viral infections can be seen in the inset&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; EBV&#44; Epstein Barr virus&#59; HCV&#44; hepatitis C virus&#59; HBV&#44; hepatitis B virus&#59; HIV&#44; human immunodeficiency virus&#59; HPV&#44; human papilloma virus&#46;</p>"
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        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Adaptation of Santos&#44; Valencia and the Expert Panel of GeSIDA&#46;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of malignancy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Susceptible population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Early diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prophylaxis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carcinoma of the anal canal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MSM&#44; women who engage in anal sex&#44; patients with genital warts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annual anal cytology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HPV vaccination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cervical carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sexually active women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annual cervical cytology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HPV vaccination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hepatocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Patients with cirrhosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal ultrasonography every 6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HBV vaccination<br>Treatment of hepatitis by HCV and HBV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lung cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Smokers older than 45 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Low-radiation contrastless chest CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Smoking cessation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colon cancer<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">People between 50 and 75 years of age&#46; Family history of colon cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annual fecal occult blood<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>colonoscopy every 5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prostate cancer<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Men older than 50 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rectal examination<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>PSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breast cancer<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Women between 50 and 70 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mammography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">In these 3 tumors&#44; the recommended measures for early diagnosis do not differ from those used in the general population&#46;</p> <p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">Abbreviations</span>&#58; MSM&#44; men who have sex with men&#59; PSA&#44; prostate-specific antigen&#59; CT&#44; computed tomography&#59; HBV&#44; hepatitis B virus&#59; HCV&#44; hepatitis C virus&#59; HPV&#44; human papilloma virus&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Measures aimed at the prevention and early diagnosis of various malignancies diagnosed in patients with human immunodeficiency virus infection&#46;</p>"
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Review
Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases?
Neoplasias e infección por el virus de la inmunodeficiencia humana: ¿enfermedades emergentes?
M.E. Valencia Ortega
Servicio de Medicina Interna-Unidad de VIH, Hospital Universitario La Paz, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years&#44; non-AIDS related diseases &#40;NARDs&#41; have increased progressively and are one of the main causes of morbidity and mortality in patients infected by the human immunodeficiency virus &#40;HIV&#41;&#46; These processes include cardiovascular and kidney diseases&#44; osteoporosis&#44; neurocognitive impairment and cancer&#44; especially non-AIDS-defining cancers &#40;NADCs&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">1&#8211;6</span></a> A recent publication showed how AIDS-related mortality has declined over time while NARD-related mortality has increased&#44; with NADCs constituting the main cause of death&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The set of malignancies presented by patients with HIV is divided into 2 groups&#58; HIV-related and non-HIV-related &#40;some of which are related to other viral diseases&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">8&#8211;16</span></a> The HIV-related malignancies include 1&#41; Kaposi&#39;s sarcoma&#44; related to the human herpesvirus type 8 virus &#40;HHV-8&#41;&#59; 2&#41; non-Hodgkin&#39;s lymphomas&#44; related to the Epstein Barr virus &#40;EBV&#41;&#59; and 3&#41; cervical carcinoma&#44; related to the human papilloma virus &#40;HPV&#41;&#46; The tumor diseases independent of HIV infection and related to viral diseases include Hodgkin&#39;s lymphoma &#40;HL&#41;&#44; related to EBV&#59; anal canal carcinoma&#44; related to HPV&#59; and hepatocarcinoma&#44; associated with the hepatitis <span class="elsevierStyleSmallCaps">C</span> &#40;HCV&#41; and B &#40;HBV&#41; viruses&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">17</span></a> Shepherd et al&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">18</span></a> proposed that the classification of malignancies be based on their relationship &#40;or lack thereof&#41; with viral infections&#46; Tumor diseases without viral involvement are represented mainly by lung carcinoma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We recently reviewed the tumor diseases in 4994 patients with HIV treated at our center from 1986 to 2016&#46; At least 1 tumor was diagnosed in 416 patients &#40;8&#46;3&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">19&#44;20</span></a> In our experience&#44; as the use of antiretroviral treatment &#40;ART&#41; has spread&#44; the incidence of AIDS-defining cancers &#40;ADCs&#41; has decreased&#44; while the incidence of NADCs has increased&#46;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">19&#44;20</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Etiopathogenesis</span><p id="par0020" class="elsevierStylePara elsevierViewall">The origin of tumor diseases in patients with HIV infection is multifactorial&#46; The most important factors are the HIV itself&#44; immunosuppression&#44; co-infection with oncogenic viruses and increased survival due to the use of ART&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">21&#8211;24</span></a> HIV is a necessary but not sufficient condition&#44; because it is not an oncogenic virus&#46; However&#44; the presence of HIV creates a condition of chronic immunosuppression&#44; which is related to ADCs&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">21&#44;25</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Immune impairment and uncontrolled HIV viremia increase the risk of developing malignancies&#44; such that an undetectable viral load and CD4&#43; lymphocyte counts greater than 500&#47;mm<span class="elsevierStyleSup">3</span> are factors that protect against the development of some tumors&#44; mainly ADCs&#46; However&#44; coinciding with the introduction of highly active ART regimens&#44; there has been an increase in NADCs because although the immunologic situation improves&#44; it is not completely restored&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">26&#8211;29</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The influence of ART on the onset of tumors is independent of the drug employed&#46; There are no differences between patients treated with regimens based on non-nucleoside reverse transcriptase inhibitors&#44; protease inhibitors and integrase inhibitors&#46;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">19&#44;20&#44;27&#8211;32</span></a> Moreover&#44; treatment interruptions&#44; which have been performed in the past&#44; increase the incidence of NADCs&#46; This outcome was established in the SMART study&#44; where all NARDs&#44; including NADCs&#44; were significantly more common in patients who had treatment interruptions than in those who continued the therapy uninterrupted&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">33</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Another important factor for the development of malignancies in patients with HIV infection is co-infection with other viruses&#44; particularly HPV&#44; which is related to cervical carcinoma&#44; anal canal carcinoma and otorhinolaryngological carcinoma&#46; Other oncogenic viruses include the previously mentioned hepatotropic viruses&#44; EBV and HHV-8&#46;<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">18&#44;34&#44;35</span></a> Ultimately&#44; the increase in survival is one of the factors that has most affected the increase in neoplastic diseases in this population&#46;<a class="elsevierStyleCrossRefs" href="#bib0575"><span class="elsevierStyleSup">36&#44;37</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Non-AIDS-defining cancers</span><p id="par0040" class="elsevierStylePara elsevierViewall">This group of malignancies is highly heterogeneous and varies by geographical area&#46; They generally appear in young patients and have an atypical presentation&#44; with large tumor masses that can quickly progress despite treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0585"><span class="elsevierStyleSup">38&#8211;42</span></a> The treatments do not differ from those used in the general population&#44; although their administration can be more complex due to drug interactions and associated comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a> These characteristics mean that mortality is always higher in the population with HIV infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">44&#44;45</span></a> Currently&#44; the overall prognosis of NADCs is poorer than that of ADCs&#46; An Italian multicenter study that analyzed the mortality rate of patients with HIV infection who were diagnosed with a malignancy observed that only 45&#37; of those who had an NADC lived to 10 years versus 60&#37; of those who had an ADC&#46;<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">46</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The most common virus-related NADCs are those of the anal canal&#44; HL and hepatocarcinoma&#46; Lung carcinoma is one of the most common smoking-related NADCs&#46; Other common tumors in the general population&#44; such as breast&#44; prostate and colon carcinoma&#44; do not have a higher incidence rate among patients with HIV&#44; and their evolutionary behavior is similar&#46;<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">25&#44;47</span></a> Nevertheless&#44; breast carcinoma is also less frequent among women with HIV but is usually more aggressive&#46;<a class="elsevierStyleCrossRefs" href="#bib0635"><span class="elsevierStyleSup">48&#44;49</span></a></p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Hodgkin&#39;s lymphoma</span><p id="par0050" class="elsevierStylePara elsevierViewall">HL is one of the most common NADCs and has an incidence rate between 15 and 30 times higher than that of the general population&#46; Patients with HL do not present significant immunosuppression&#46; In a number of series&#44; the incidence of LH was higher the greater the CD4&#43; lymphocyte count&#46;<a class="elsevierStyleCrossRefs" href="#bib0645"><span class="elsevierStyleSup">50&#44;51</span></a> To explain this finding&#44; it has been speculated that there is a possible relationship between Reed&#8211;Sternberg cells and the CD4&#43; lymphocytes that surround them&#46; In this respect&#44; Reed&#8211;Sternberg cells&#44; which produce cytokines&#44; attract nearby CD4&#43; and other inflammatory cells&#46; As a result&#44; these CD4&#43; cells are activated and send the necessary signals for the proliferation and survival of malignant cells&#44; which would be more pronounced in patients with higher CD4&#43; lymphocyte counts&#46;<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">52</span></a> In most cases&#44; HL in patients with HIV presents in stage IVB&#44; and the treatment does not differ from that used in HIV-negative patients&#46; As with any other type of tumor&#44; the use of ART and the prophylaxis of opportunistic infections are an essential part of the treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">3&#44;43&#44;53</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In patients with HIV infection&#44; HL survival is determined by the tumor-associated prognostic factors&#59; however&#44; ART has primary importance&#46; In a Spanish multicenter study&#44;<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">54</span></a> the overall survival of these patients at 10 years was 60&#37;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Hepatocarcinoma</span><p id="par0060" class="elsevierStylePara elsevierViewall">The incidence rate of hepatocarcinoma in the population with HIV infection is 8 times higher than that of the general population&#44; although its etiopathogenesis and evolutionary behavior do not differ significantly between the 2 populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0670"><span class="elsevierStyleSup">55&#8211;57</span></a> The factors involved in the development of hepatocarcinoma are chronic viral hepatitis &#40;especially hepatitis C in our community&#41;&#44; cirrhosis of any etiology and alcohol consumption&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The main and possibly only prevention measure is HCV treatment&#59; however&#44; risk reduction in patients with sustained response to antiviral treatment is not absolute&#46; We therefore need to continue using screening strategies even when the HCV infection has been cured&#46;<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">58</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Carcinoma of the anal canal</span><p id="par0070" class="elsevierStylePara elsevierViewall">Carcinoma of the anal canal is closely related to the oncogenic genotypes of HPV&#44; which is detected in more than 90&#37; of cases&#46; While the incidence rate of this carcinoma in the population with HIV infection is 55&#8211;144&#47;100&#44;000 patients&#47;year&#44; the rate in the general population is only 1&#8211;1&#46;5&#47;100&#44;000 patients&#47;year&#46;<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">59</span></a> Homosexual men are at greatest risk for this disease&#44; but it has been diagnosed in women who have anal sex and in patients with genital warts&#46;<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">59</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The main recommended preventive measures are the use of condoms &#40;although they do not provide protection in all cases&#41; and vaccination&#44; whose efficacy in preventing cervical carcinoma has already been proven&#46;<a class="elsevierStyleCrossRefs" href="#bib0695"><span class="elsevierStyleSup">60&#44;61</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">According to the recommendations of the AIDS workgroup &#40;GESIDA&#41; of the Spanish Society of Infectious Diseases and Clinical Microbiology&#44; anal cytology should be performed for the early diagnosis of at-risk patients&#44; regardless of the presence or absence of HPV &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Lung carcinoma</span><p id="par0085" class="elsevierStylePara elsevierViewall">Lung carcinoma is the most common tumor&#44; both in the population with HIV infection and the general population&#44; and has a close relationship with tobacco use&#46; However&#44; in patients with HIV infection&#44; regardless of their smoking habit&#44; lung carcinoma has been observed to be 2&#8211;4 times more common&#44; occurring at younger ages&#44; with a more aggressive behavior and a poorer prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0705"><span class="elsevierStyleSup">62&#8211;65</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Lung cancer is one of the main causes of death&#46; Until recently&#44; however&#44; there has been no screening method that enabled an early diagnosis&#46; Based on the published data of the National Lung Screening Trial in 2013&#44;<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">66</span></a> the current proposal is to use low-radiation computed tomography for the at-risk population without HIV&#44; because it has been shown to be useful in the early diagnosis of this tumor&#44; although its cost-effectiveness is still being evaluated&#46; In the population with HIV infection&#44; this aspect has been scarcely studied&#46; GESIDA has therefore conducted a multicenter study to assess the efficacy of this measure &#40;GESIDA 8815&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0730"><span class="elsevierStyleSup">67</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Treatment of non-AIDS-defining cancers</span><p id="par0095" class="elsevierStylePara elsevierViewall">Treatment of NADCs&#44; as with ADCs&#44; is based on 3 fundamental pillars<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">44&#44;68&#8211;70</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Antineoplastic treatment should be the same as that used for HIV&#8722; patients&#46; If this premise is not considered&#44; the mortality can increase because inappropriate therapies will be performed&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">71</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Treatment of the HIV infection with an effective and safe &#40;without drug interactions&#41; ART should be started early&#46;<a class="elsevierStyleCrossRefs" href="#bib0755"><span class="elsevierStyleSup">72&#8211;74</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Prophylaxis and treatment of opportunistic infections is an essential measure and should be performed for infections directly related to the immunosuppression and for those infections &#40;such as tuberculosis&#41; that have a high incidence rate in the community&#46; After employing chemotherapy or radiation therapy&#44; the total CD4&#43; lymphocyte count will be reduced by 30&#8211;50&#37; compared with baseline&#46; Regaining pretreatment levels will take more than 6&#8211;12 months&#46;<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">75</span></a> Always performing prophylaxis with cotrimoxazole is therefore recommended&#44; even if at the start of treatment the CD4&#43; lymphocyte counts are greater than 200&#47;mm<span class="elsevierStyleSup">3</span>&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Early diagnosis and prevention</span><p id="par0115" class="elsevierStylePara elsevierViewall">With regard to the measures aimed at the early diagnosis of malignancies&#44; none of the ART guidelines &#40;except those of the European AIDS Clinical Society<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">76</span></a>&#41; expressly mention this point&#46; In Spain&#44; GESIDA has prepared a document &#40;drafted independently from the ART guidelines&#41; on managing NADCs&#44; covering both prevention and early diagnosis&#44; which basically does not differ from the recommendations for the general population &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a> According to the recommendations&#44; the most important preventive measures with proven efficacy are developing healthy life habits &#40;reducing alcohol and tobacco consumption&#41;&#44; HCV treatment and the use of vaccines against HPV and&#44; to a lesser extent&#44; HBV&#46;<a class="elsevierStyleCrossRefs" href="#bib0610"><span class="elsevierStyleSup">43&#44;57&#44;58&#44;60&#44;61&#44;77&#8211;79</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusions</span><p id="par0120" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#46;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Most malignancies &#40;ADCs and NADCs&#41; that appear in patients with HIV infection are related to viral infections&#46; NADCs have a higher frequency and greater severity than ADCs&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#46;</span><p id="par0130" class="elsevierStylePara elsevierViewall">An undetectable viral load &#40;HIV&#41; and CD4&#43; lymphocyte counts higher than 500&#47;mm<span class="elsevierStyleSup">3</span> are factors that protect against the development of some tumors&#44; mainly ADCs&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#46;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Treatment for malignancies in patients with HIV resembles that used in the general population&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4&#46;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Prophylaxis of opportunistic infections should be employed while administering chemotherapy&#44; even when CD4 counts are higher than 200&#47;mm<span class="elsevierStyleSup">3</span>&#46;</p></li></ul></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Hepatocarcinoma"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Since the start of the human immunodeficiency virus &#40;HIV&#41; epidemic&#44; tumor disease among patients has been significant&#46; The collection of malignancies can be divided primarily into 2 groups&#58; those associated with HIV &#40;all of which are related to viral diseases&#41; and those not associated with HIV &#40;only some of which are associated with viral diseases&#41;&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The origin of these malignancies is multifactorial&#44; and the main causes that have led to an increase in tumor disease are immunosuppression&#44; coinfection with oncogenic viruses and life prolongation secondary to the use of antiretroviral therapy&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Establishing the general characteristics of the undiagnosed AIDS tumors is difficult&#44; mainly because they are a highly heterogeneous group formed by malignancies of a diverse nature&#46; The treatments do not differ from those used in the general population&#44; although the management can be more difficult due to the late diagnosis&#44; drug interactions and associated comorbidities&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Desde los inicios de la epidemia del virus de la inmunodeficiencia humana &#40;VIH&#41;&#44; la patolog&#237;a tumoral ha sido muy importante&#46; El conjunto de las neoplasias se puede dividir b&#225;sicamente en 2 grupos&#58; las asociadas al VIH&#44; todas ellas relacionadas con enfermedades virales&#44; y las no asociadas al VIH&#44; entre las que algunas est&#225;n asociadas a enfermedades virales y otras no&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El origen es multifactorial y las principales causas que han llevado a que se produzca un aumento de la patolog&#237;a tumoral son la inmunodepresi&#243;n&#44; la coinfecci&#243;n con virus oncog&#233;nicos y la prolongaci&#243;n de la vida secundaria al uso de tratamiento antirretroviral&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Establecer las caracter&#237;sticas generales de los tumores no diagn&#243;sticos de sida es dif&#237;cil fundamentalmente porque son un grupo muy heterog&#233;neo formado por neoplasias de diversa &#237;ndole&#46; Los tratamientos no difieren de los empleados en la poblaci&#243;n general&#44; aunque el manejo puede ser m&#225;s dif&#237;cil por el diagn&#243;stico tard&#237;o&#44; las interacciones medicamentosas y las comorbilidades asociadas&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Valencia Ortega ME&#46; Neoplasias e infecci&#243;n por el virus de la inmunodeficiencia humana&#58; &#191;enfermedades emergentes&#63;&#46; Rev Clin Esp&#46; 2018&#59;218&#58;149&#8211;155&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Classification of the main malignancies presented by patients with human immunodeficiency virus infection&#46; Malignancies related to viral infections can be seen in the inset&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; EBV&#44; Epstein Barr virus&#59; HCV&#44; hepatitis C virus&#59; HBV&#44; hepatitis B virus&#59; HIV&#44; human immunodeficiency virus&#59; HPV&#44; human papilloma virus&#46;</p>"
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        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Adaptation of Santos&#44; Valencia and the Expert Panel of GeSIDA&#46;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of malignancy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Susceptible population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Early diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prophylaxis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carcinoma of the anal canal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MSM&#44; women who engage in anal sex&#44; patients with genital warts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annual anal cytology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HPV vaccination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cervical carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sexually active women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annual cervical cytology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HPV vaccination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hepatocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Patients with cirrhosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal ultrasonography every 6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HBV vaccination<br>Treatment of hepatitis by HCV and HBV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lung cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Smokers older than 45 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Low-radiation contrastless chest CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Smoking cessation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colon cancer<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">People between 50 and 75 years of age&#46; Family history of colon cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annual fecal occult blood<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>colonoscopy every 5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prostate cancer<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Men older than 50 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rectal examination<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>PSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breast cancer<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Women between 50 and 70 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mammography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">In these 3 tumors&#44; the recommended measures for early diagnosis do not differ from those used in the general population&#46;</p> <p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">Abbreviations</span>&#58; MSM&#44; men who have sex with men&#59; PSA&#44; prostate-specific antigen&#59; CT&#44; computed tomography&#59; HBV&#44; hepatitis B virus&#59; HCV&#44; hepatitis C virus&#59; HPV&#44; human papilloma virus&#46;</p>"
            ]
          ]
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Measures aimed at the prevention and early diagnosis of various malignancies diagnosed in patients with human immunodeficiency virus infection&#46;</p>"
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Article information
ISSN: 22548874
Original language: English
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