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Which One Is Better: AIDS Related or HIV Associated?

Mersin University, Faculty of Medicine, Department of Medical Oncology, Mersin, Turkey

Gülcan Abali

Adana Numune Research and Teaching Hospital, Cardiology Clinic, Adana, Turkey

Sercan Aksoy

Hacettepe University, Institute of Oncology, Department of Medical Oncology, Ankara, Turkey

To the Editor:

We have read the article by François Boué et al on AIDS-related lymphoma.¹ The authors stated that rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) is a simple and effective schedule for HIV-associated lymphoma.¹ The authors used the terms HIV-associated and AIDS-related interchangeably throughout their article. Although everybody who read it surely understood that they are more or less the same entity, it is crucial to use the most correct terminology for scientific communication, in our point of view. Which one defines malignancies developing in individuals infected with HIV better? We have some comments.

Caused by HIV, AIDS is the profound immunodeficiency state characterized by opportunistic infections and Kaposi's sarcoma, non-Hodgkin's lymphoma, and cervical cancer—the AIDS-defining cancers. By definition, when they are diagnosed in a patient infected with CD4+ count less than 200 cells/uL that patient has AIDS. Therefore, the term AIDS-related seems better suited for AIDS-defining cancers.

However, non–AIDS-defining cancers do occur in individuals infected with HIV. Several population-based studies indicated that relative risks for such malignancies with the exception of anal cancer is minimally increased during the pre-AIDS period,^2-4 meaning that HIV positivity does not substantially increase risk of malignancy before inducing AIDS. Therefore, the term AIDS related seems more correct for non–AIDS-defining cancers, as well.

Furthermore, highly active antiretroviral therapy prevents immunodeficiency and decreased incidences of malignancies, but can not eradicate HIV. This observation means that AIDS is necessary for the development of most cancers.

In conclusion, we kindly suggest that AIDS related be preferred over HIV associated when referring to all malignancies in individuals with HIV infection.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The authors indicated no potential conflicts of interest.

REFERENCES

1. Boué F, Gabarre J, Gisselbrecht C, et al: Phase II trial of CHOP plus rituximab in patients with HIV-associated non-Hodgkin's lymphoma. J Clin Oncol 24:4123-4128, 2006[Abstract/Free Full Text]

2. Grulich AE, Li Y, McDonald A, et al: Rates of non-AIDS-defining cancers in people with HIV infection before and after AIDS diagnosis. AIDS 16:1155-1161, 2002[CrossRef][Medline]

3. Li Y, Law M, McDonald A, et al: Estimation of risk of cancers before occurrence of acquired immunodeficiency syndrome in persons infected with human immunodeficiency virus. Am J Epidemiol 155:153-158, 2002[Abstract/Free Full Text]

4. Frisch M, Biggar RJ, Engels EA, et al: Association of cancer with AIDS-related immunosuppression in adults. JAMA 285:1736-1745, 2001[Abstract/Free Full Text]

Related Article

• Phase II Trial of CHOP Plus Rituximab in Patients With HIV-Associated Non-Hodgkin's Lymphoma
  François Boué, Jean Gabarre, Christian Gisselbrecht, Jacques Reynes, Antoine Cheret, Fabrice Bonnet, Eric Billaud, Martine Raphael, Remi Lancar, and Dominique Costagliola
  JCO 2006 24: 4123-4128 [Abstract] [Full Text]

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