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J Acquir Immune Defic Syndr. 2014 Sep 1;67 Suppl 1:S17-26. doi: 10.1097/QAI.0000000000000255.

Challenges in the detection, prevention, and treatment of HIV-associated malignancies in low- and middle-income countries in Africa.

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*Office of Research and Training, Institute of Human Virology Nigeria, Abuja, Nigeria, and Department of Epidemiology and Public Health, Institute of Human Virology and Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD; †Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; ‡AIDS Malignancy Program, Office of HIV and AIDS Malignancy, National Cancer Institute, National Institutes of Health, Bethesda, MD; §Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD; ‖Centre INSERM U 897-Epidémiologie-Biostatistique, Université de Bordeaux, Inserm U 897- Epidémiologie et Biostatistiques, L'Institut de Santé Publique, d'Épidémiologie et de Développement de l'Université de Bordeaux, Bordeaux, France; ¶Institute of Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; and #AIDS Malignancy Consortium and Memorial Sloan-Kettering Cancer Center (emerita), New York, NY.


Cancers associated with immunosuppression and infections have long been recognized as a major complication of HIV/AIDS. More recently, persons living with HIV are increasingly diagnosed with a wider spectrum of HIV-associated malignancies (HIVAM) as they live longer on combination antiretroviral therapy. This has spurred research to characterize the epidemiology and determine the optimal management of HIVAM with a focus on low-and middle-income countries (LMICs). Given background coinfections, environmental exposures, host genetic profiles, antiretroviral therapy usage, and varying capacities for early diagnosis and treatment, one can expect the biology of cancers in HIV-infected persons in LMICs to have a significant impact on chronic HIV care, as is now the case in high-income countries. Thus, new strategies must be developed to effectively prevent, diagnose, and treat HIVAM in LMICs; provide physical/clinical infrastructures; train the cancer and HIV workforce; and expand research capacity-particularly given the challenges posed by the limitations on available transportation and financial resources and the population's general rural concentration. Opportunities exist to extend resources supported by the President's Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria to improve the health-care infrastructure and train the personnel required to prevent and manage cancers in persons living with HIV. These HIV chronic care infrastructures could also serve cancer patients regardless of their HIV status, facilitating long-term care and treatment for persons who do not live near cancer centers, so that they receive the same degree of care as those receiving chronic HIV care today.

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