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HIV-associated malignancies

Key sources
The following summarized guidelines for the evaluation and management of HIV-associated malignancies are prepared by our editorial team based on guidelines from the British HIV Association (BHIVA 2014).
1

Guidelines

1.Diagnostic investigations

Evaluation for Kaposi sarcoma
Confirm Kaposi sarcoma histologically.
B
Consider avoiding routine CT scans, bronchoscopy or gastrointestinal endoscopy in the absence of symptoms.
D
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  • Evaluation for Castleman's disease

  • Evaluation for anal cancer

2.Medical management

Highly active antiretroviral therapy: initiate HAART in all patients diagnosed with Kaposi sarcoma.
B

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  • Irradiation of blood products

3.Specific circumstances

Patients with Kaposi's sarcoma: initiate chemotherapy along with HAART for patients with T1 advanced stage Kaposi's sarcoma.
B
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  • Patients with Hodgkin's lymphoma

  • Patients with diffuse large-B cell lymphoma

  • Patients with Burkitt's lymphoma

  • Patients with multicentric Castleman's disease

  • Patients with primary CNS lymphoma

  • Patients with primary effusion lymphoma

  • Patients with plasmablastic lymphoma

  • Patients with relapsed/refractory aggressive lymphoma

  • Patients with anal cancer

  • Patients with CIN and cervical cancer

  • Patients with non-AIDS-defining malignancies

4.Preventative measures

Immunizations
Provide influenza immunization to all patients with HIV-associated malignancies on an annual basis.
B
Provide pneumococcal immunization and HBV immunization.
B

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  • Prophylaxis against opportunistic infections

5.Follow-up and surveillance

Indications for referral to specialized centers: refer all patients with HIV and malignancy to centers that have developed expertise in the management of these diseases.
B

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  • Consideration for enrollment in clinical trials

  • Monitoring for patients with Hodgkin's lymphoma

  • Monitoring for patients with multicentric Castleman's disease