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array:24 [ "pii" => "S2254887417301108" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.10.001" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "1426" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Rev Clin Esp. 2018;218:149-55" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0014256517301856" "issn" => "00142565" "doi" => "10.1016/j.rce.2017.07.011" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "1426" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Rev Clin Esp. 2018;218:149-55" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 91 "formatos" => array:2 [ "HTML" => 58 "PDF" => 33 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Revisión</span>" "titulo" => "Neoplasias e infección por el virus de la inmunodeficiencia humana: ¿enfermedades emergentes?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "149" "paginaFinal" => "155" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1610 "Ancho" => 2328 "Tamanyo" => 147796 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Algoritmo para el diagnóstico precoz del carcinoma del canal anal.</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ASCUS: células de significado incierto; SIL: lesión intraepitelial.</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Fuente: adaptación de Santos, Valencia y Panel de expertos de GeSIDA<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.E. Valencia Ortega" "autores" => array:1 [ 0 => array:2 [ "nombre" => "M.E." "apellidos" => "Valencia Ortega" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887417301108" "doi" => "10.1016/j.rceng.2017.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417301108?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256517301856?idApp=WRCEE" "url" => "/00142565/0000021800000003/v1_201803280442/S0014256517301856/v1_201803280442/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2254887418300031" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.12.003" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "1455" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Clin Esp. 2018;218:156" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Medicine in Image</span>" "titulo" => "77-year-old woman with pulse abnormalities" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "156" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mujer de 77 años con anomalías en el pulso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 609 "Ancho" => 1000 "Tamanyo" => 61541 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Rubio-Gracia, M. Sánchez-Marteles, M.P. Burillo-Fuertes" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Rubio-Gracia" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Sánchez-Marteles" ] 2 => array:2 [ "nombre" => "M.P." "apellidos" => "Burillo-Fuertes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256517302862" "doi" => "10.1016/j.rce.2017.12.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256517302862?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418300031?idApp=WRCEE" "url" => "/22548874/0000021800000003/v1_201803280546/S2254887418300031/v1_201803280546/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S225488741730125X" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.09.004" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "1439" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2018;218:142-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "The internist as clinical ethics consultant: An antidote to “the barbarism of specialisation” in hospital practice" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "142" "paginaFinal" => "148" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El internista como consultor de ética clínica: un antídoto contra «la barbarie del especialismo» en la práctica hospitalaria" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Real de Asúa, P. Rodriguez del Pozo, J.J. Fins" "autores" => array:3 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Real de Asúa" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Rodriguez del Pozo" ] 2 => array:2 [ "nombre" => "J.J." "apellidos" => "Fins" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256517302205" "doi" => "10.1016/j.rce.2017.09.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256517302205?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225488741730125X?idApp=WRCEE" "url" => "/22548874/0000021800000003/v1_201803280546/S225488741730125X/v1_201803280546/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "149" "paginaFinal" => "155" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M.E. Valencia Ortega" "autores" => array:1 [ 0 => array:3 [ "nombre" => "M.E." "apellidos" => "Valencia Ortega" "email" => array:1 [ 0 => "eulalia.valencia@salud.madrid.org" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna-Unidad de VIH, Hospital Universitario La Paz, Madrid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neoplasias e infección por el virus de la inmunodeficiencia humana: ¿enfermedades emergentes?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2313 "Ancho" => 1588 "Tamanyo" => 179761 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Classification of the main malignancies presented by patients with human immunodeficiency virus infection. Malignancies related to viral infections can be seen in the inset.</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: EBV, Epstein Barr virus; HCV, hepatitis C virus; HBV, hepatitis B virus; HIV, human immunodeficiency virus; HPV, human papilloma virus.</p>" ] ] ] "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, non-AIDS related diseases (NARDs) have increased progressively and are one of the main causes of morbidity and mortality in patients infected by the human immunodeficiency virus (HIV). These processes include cardiovascular and kidney diseases, osteoporosis, neurocognitive impairment and cancer, especially non-AIDS-defining cancers (NADCs).<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">1–6</span></a> A recent publication showed how AIDS-related mortality has declined over time while NARD-related mortality has increased, with NADCs constituting the main cause of death.<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: HIV-related and non-HIV-related (some of which are related to other viral diseases) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">8–16</span></a> The HIV-related malignancies include 1) Kaposi's sarcoma, related to the human herpesvirus type 8 virus (HHV-8); 2) non-Hodgkin's lymphomas, related to the Epstein Barr virus (EBV); and 3) cervical carcinoma, related to the human papilloma virus (HPV). The tumor diseases independent of HIV infection and related to viral diseases include Hodgkin's lymphoma (HL), related to EBV; anal canal carcinoma, related to HPV; and hepatocarcinoma, associated with the hepatitis <span class="elsevierStyleSmallCaps">C</span> (HCV) and B (HBV) viruses.<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">17</span></a> Shepherd et al.<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">18</span></a> proposed that the classification of malignancies be based on their relationship (or lack thereof) with viral infections. Tumor diseases without viral involvement are represented mainly by lung carcinoma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</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. At least 1 tumor was diagnosed in 416 patients (8.3%).<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">19,20</span></a> In our experience, as the use of antiretroviral treatment (ART) has spread, the incidence of AIDS-defining cancers (ADCs) has decreased, while the incidence of NADCs has increased.<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">19,20</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. The most important factors are the HIV itself, immunosuppression, co-infection with oncogenic viruses and increased survival due to the use of ART.<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">21–24</span></a> HIV is a necessary but not sufficient condition, because it is not an oncogenic virus. However, the presence of HIV creates a condition of chronic immunosuppression, which is related to ADCs.<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">21,25</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Immune impairment and uncontrolled HIV viremia increase the risk of developing malignancies, such that an undetectable viral load and CD4+ lymphocyte counts greater than 500/mm<span class="elsevierStyleSup">3</span> are factors that protect against the development of some tumors, mainly ADCs. However, coinciding with the introduction of highly active ART regimens, there has been an increase in NADCs because although the immunologic situation improves, it is not completely restored.<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">26–29</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The influence of ART on the onset of tumors is independent of the drug employed. There are no differences between patients treated with regimens based on non-nucleoside reverse transcriptase inhibitors, protease inhibitors and integrase inhibitors.<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">19,20,27–32</span></a> Moreover, treatment interruptions, which have been performed in the past, increase the incidence of NADCs. This outcome was established in the SMART study, where all NARDs, including NADCs, were significantly more common in patients who had treatment interruptions than in those who continued the therapy uninterrupted.<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, particularly HPV, which is related to cervical carcinoma, anal canal carcinoma and otorhinolaryngological carcinoma. Other oncogenic viruses include the previously mentioned hepatotropic viruses, EBV and HHV-8.<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">18,34,35</span></a> Ultimately, the increase in survival is one of the factors that has most affected the increase in neoplastic diseases in this population.<a class="elsevierStyleCrossRefs" href="#bib0575"><span class="elsevierStyleSup">36,37</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. They generally appear in young patients and have an atypical presentation, with large tumor masses that can quickly progress despite treatment.<a class="elsevierStyleCrossRefs" href="#bib0585"><span class="elsevierStyleSup">38–42</span></a> The treatments do not differ from those used in the general population, although their administration can be more complex due to drug interactions and associated comorbidities.<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.<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">44,45</span></a> Currently, the overall prognosis of NADCs is poorer than that of ADCs. An Italian multicenter study that analyzed the mortality rate of patients with HIV infection who were diagnosed with a malignancy observed that only 45% of those who had an NADC lived to 10 years versus 60% of those who had an ADC.<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, HL and hepatocarcinoma. Lung carcinoma is one of the most common smoking-related NADCs. Other common tumors in the general population, such as breast, prostate and colon carcinoma, do not have a higher incidence rate among patients with HIV, and their evolutionary behavior is similar.<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">25,47</span></a> Nevertheless, breast carcinoma is also less frequent among women with HIV but is usually more aggressive.<a class="elsevierStyleCrossRefs" href="#bib0635"><span class="elsevierStyleSup">48,49</span></a></p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Hodgkin'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. Patients with HL do not present significant immunosuppression. In a number of series, the incidence of LH was higher the greater the CD4+ lymphocyte count.<a class="elsevierStyleCrossRefs" href="#bib0645"><span class="elsevierStyleSup">50,51</span></a> To explain this finding, it has been speculated that there is a possible relationship between Reed–Sternberg cells and the CD4+ lymphocytes that surround them. In this respect, Reed–Sternberg cells, which produce cytokines, attract nearby CD4+ and other inflammatory cells. As a result, these CD4+ cells are activated and send the necessary signals for the proliferation and survival of malignant cells, which would be more pronounced in patients with higher CD4+ lymphocyte counts.<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">52</span></a> In most cases, HL in patients with HIV presents in stage IVB, and the treatment does not differ from that used in HIV-negative patients. As with any other type of tumor, the use of ART and the prophylaxis of opportunistic infections are an essential part of the treatment.<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">3,43,53</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In patients with HIV infection, HL survival is determined by the tumor-associated prognostic factors; however, ART has primary importance. In a Spanish multicenter study,<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">54</span></a> the overall survival of these patients at 10 years was 60%.</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, although its etiopathogenesis and evolutionary behavior do not differ significantly between the 2 populations.<a class="elsevierStyleCrossRefs" href="#bib0670"><span class="elsevierStyleSup">55–57</span></a> The factors involved in the development of hepatocarcinoma are chronic viral hepatitis (especially hepatitis C in our community), cirrhosis of any etiology and alcohol consumption.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The main and possibly only prevention measure is HCV treatment; however, risk reduction in patients with sustained response to antiviral treatment is not absolute. We therefore need to continue using screening strategies even when the HCV infection has been cured.<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, which is detected in more than 90% of cases. While the incidence rate of this carcinoma in the population with HIV infection is 55–144/100,000 patients/year, the rate in the general population is only 1–1.5/100,000 patients/year.<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">59</span></a> Homosexual men are at greatest risk for this disease, but it has been diagnosed in women who have anal sex and in patients with genital warts.<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 (although they do not provide protection in all cases) and vaccination, whose efficacy in preventing cervical carcinoma has already been proven.<a class="elsevierStyleCrossRefs" href="#bib0695"><span class="elsevierStyleSup">60,61</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">According to the recommendations of the AIDS workgroup (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology, anal cytology should be performed for the early diagnosis of at-risk patients, regardless of the presence or absence of HPV (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<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, both in the population with HIV infection and the general population, and has a close relationship with tobacco use. However, in patients with HIV infection, regardless of their smoking habit, lung carcinoma has been observed to be 2–4 times more common, occurring at younger ages, with a more aggressive behavior and a poorer prognosis.<a class="elsevierStyleCrossRefs" href="#bib0705"><span class="elsevierStyleSup">62–65</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Lung cancer is one of the main causes of death. Until recently, however, there has been no screening method that enabled an early diagnosis. Based on the published data of the National Lung Screening Trial in 2013,<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, because it has been shown to be useful in the early diagnosis of this tumor, although its cost-effectiveness is still being evaluated. In the population with HIV infection, this aspect has been scarcely studied. GESIDA has therefore conducted a multicenter study to assess the efficacy of this measure (GESIDA 8815).<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, as with ADCs, is based on 3 fundamental pillars<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">44,68–70</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0100" class="elsevierStylePara elsevierViewall">Antineoplastic treatment should be the same as that used for HIV− patients. If this premise is not considered, the mortality can increase because inappropriate therapies will be performed.<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">71</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0105" class="elsevierStylePara elsevierViewall">Treatment of the HIV infection with an effective and safe (without drug interactions) ART should be started early.<a class="elsevierStyleCrossRefs" href="#bib0755"><span class="elsevierStyleSup">72–74</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</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 (such as tuberculosis) that have a high incidence rate in the community. After employing chemotherapy or radiation therapy, the total CD4+ lymphocyte count will be reduced by 30–50% compared with baseline. Regaining pretreatment levels will take more than 6–12 months.<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">75</span></a> Always performing prophylaxis with cotrimoxazole is therefore recommended, even if at the start of treatment the CD4+ lymphocyte counts are greater than 200/mm<span class="elsevierStyleSup">3</span>.</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, none of the ART guidelines (except those of the European AIDS Clinical Society<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">76</span></a>) expressly mention this point. In Spain, GESIDA has prepared a document (drafted independently from the ART guidelines) on managing NADCs, covering both prevention and early diagnosis, which basically does not differ from the recommendations for the general population (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a> According to the recommendations, the most important preventive measures with proven efficacy are developing healthy life habits (reducing alcohol and tobacco consumption), HCV treatment and the use of vaccines against HPV and, to a lesser extent, HBV.<a class="elsevierStyleCrossRefs" href="#bib0610"><span class="elsevierStyleSup">43,57,58,60,61,77–79</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.</span><p id="par0125" class="elsevierStylePara elsevierViewall">Most malignancies (ADCs and NADCs) that appear in patients with HIV infection are related to viral infections. NADCs have a higher frequency and greater severity than ADCs.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2.</span><p id="par0130" class="elsevierStylePara elsevierViewall">An undetectable viral load (HIV) and CD4+ lymphocyte counts higher than 500/mm<span class="elsevierStyleSup">3</span> are factors that protect against the development of some tumors, mainly ADCs.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3.</span><p id="par0135" class="elsevierStylePara elsevierViewall">Treatment for malignancies in patients with HIV resembles that used in the general population.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4.</span><p id="par0140" class="elsevierStylePara elsevierViewall">Prophylaxis of opportunistic infections should be employed while administering chemotherapy, even when CD4 counts are higher than 200/mm<span class="elsevierStyleSup">3</span>.</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.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1009460" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec968996" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1009461" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec968997" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Etiopathogenesis" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Non-AIDS-defining cancers" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Hodgkin's lymphoma" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Hepatocarcinoma" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Carcinoma of the anal canal" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Lung carcinoma" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Treatment of non-AIDS-defining cancers" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Early diagnosis and prevention" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-21" "fechaAceptado" => "2017-07-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec968996" "palabras" => array:3 [ 0 => "Undiagnosed AIDS tumors" 1 => "Malignancies and HIV" 2 => "Mortality" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec968997" "palabras" => array:3 [ 0 => "Tumores no diagnósticos de sida" 1 => "Neoplasias y VIH" 2 => "Mortalidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Since the start of the human immunodeficiency virus (HIV) epidemic, tumor disease among patients has been significant. The collection of malignancies can be divided primarily into 2 groups: those associated with HIV (all of which are related to viral diseases) and those not associated with HIV (only some of which are associated with viral diseases).</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The origin of these malignancies is multifactorial, and the main causes that have led to an increase in tumor disease are immunosuppression, coinfection with oncogenic viruses and life prolongation secondary to the use of antiretroviral therapy.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Establishing the general characteristics of the undiagnosed AIDS tumors is difficult, mainly because they are a highly heterogeneous group formed by malignancies of a diverse nature. The treatments do not differ from those used in the general population, although the management can be more difficult due to the late diagnosis, drug interactions and associated comorbidities.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "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 (VIH), la patología tumoral ha sido muy importante. El conjunto de las neoplasias se puede dividir básicamente en 2 grupos: las asociadas al VIH, todas ellas relacionadas con enfermedades virales, y las no asociadas al VIH, entre las que algunas están asociadas a enfermedades virales y otras no.</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 patología tumoral son la inmunodepresión, la coinfección con virus oncogénicos y la prolongación de la vida secundaria al uso de tratamiento antirretroviral.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Establecer las características generales de los tumores no diagnósticos de sida es difícil fundamentalmente porque son un grupo muy heterogéneo formado por neoplasias de diversa índole. Los tratamientos no difieren de los empleados en la población general, aunque el manejo puede ser más difícil por el diagnóstico tardío, las interacciones medicamentosas y las comorbilidades asociadas.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Valencia Ortega ME. Neoplasias e infección por el virus de la inmunodeficiencia humana: ¿enfermedades emergentes?. Rev Clin Esp. 2018;218:149–155.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2313 "Ancho" => 1588 "Tamanyo" => 179761 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Classification of the main malignancies presented by patients with human immunodeficiency virus infection. Malignancies related to viral infections can be seen in the inset.</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: EBV, Epstein Barr virus; HCV, hepatitis C virus; HBV, hepatitis B virus; HIV, human immunodeficiency virus; HPV, human papilloma virus.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Adaptation of Santos, Valencia and the Expert Panel of GeSIDA.<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">43</span></a>" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1610 "Ancho" => 2328 "Tamanyo" => 146548 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Algorithm for the early diagnosis of carcinoma of the anal canal.</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ASCUS, atypical squamous cells of undetermined significance; IL, intraepithelial lesion.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \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 \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 \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 \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 \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MSM, women who engage in anal sex, patients with genital warts \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HPV vaccination \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 \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 \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HPV vaccination \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 \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 \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 \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 \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 \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 \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Smoking cessation \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> \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. Family history of colon cancer \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>±<span class="elsevierStyleHsp" style=""></span>colonoscopy every 5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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> \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 \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>±<span class="elsevierStyleHsp" style=""></span>PSA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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> \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mammography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1709674.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">In these 3 tumors, the recommended measures for early diagnosis do not differ from those used in the general population.</p> <p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">Abbreviations</span>: MSM, men who have sex with men; PSA, prostate-specific antigen; CT, computed tomography; HBV, hepatitis B virus; HCV, hepatitis C virus; HPV, human papilloma virus.</p>" ] ] ] "descripcion" => array:1 [ "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.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:79 [ 0 => array:3 [ "identificador" => "bib0400" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality, causes of death and associated factors relate to a large HIV population-based cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. 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