PeIN and established penile cancer should be managed by specialized MDTs in specialized urological centres according to established guidelines [110–113]. The focus is on preventative or curative tissue conserving treatment and assessment of the regional lymphatics with an established role for sentinel node
biopsy. Only case reports and small retrospective series exist for other malignancies. HIV-positive acute myeloid leukaemia patients achieve remission with intensive treatment but this is poorly tolerated and most succumb to nonopportunistic infections. Survival is generally worse and CD4 cell count is a strong predictor of poor prognosis . Head and neck cancers and breast cancers may be more aggressive than in their HIV-negative counterparts, although radiation
therapy in the former RAD001 mouse appears to be well tolerated with expected toxicity profiles [115,116]. There is the decreased incidence of prostate and breast cancer in HIV, the reason for which does not appear to be related to hormone deficiency [2,117]. The reduced incidence of prostate cancer may be explained by differential PSA screening in the HIV-positive and general populations . Small case studies suggest that HIV-positive patients with prostate cancer should be managed similarly to their HIV-negative counterparts and that outcomes are not significantly altered by HIV status [119,120]. We recommend that patients with these less well-described cancers are offered the standard care offered to HIV-negative patients. Treatment should be given in conjunction with HIV doctors. Prospective databases Saracatinib are required for this group. We recommend that the management of people living with HIV with non-AIDS-defining malignancy should be in a centre with adequate experience and requires a joint MDT including both oncologists with experience
of managing HIV-related malignancy and HIV physicians (level of evidence 1C). We recommend that patients with NADM should be offered the standard care given to HIV-negative patients (level of evidence 1C). We recommend that all potential interactions between HAART, opportunistic infection prophylaxis and cancer therapy should be considered (level of evidence 1C). 1 Powles T, Bower M, Shamash J et al. Outcome of patients with HIV-related PtdIns(3,4)P2 germ cell tumours: a case-control study. Br J Cancer 2004; 90: 1526–1530. 2 Frisch M, Biggar RJ, Engels EA, Goedert JJ. Association of cancer with AIDS-related immunosuppression in adults. JAMA 2001; 285: 1736–1745. 3 Herida M, Mary-Krause M, Kaphan R et al. Incidence of non-AIDS-defining cancers before and during the highly active antiretroviral therapy era in a cohort of human immunodeficiency virus-infected patients. J Clin Oncol 2003; 21: 3447–3453. 4 Serraino D, Boschini A, Carrieri P et al. Cancer risk among men with, or at risk of, HIV infection in southern Europe. AIDS 2000; 14: 553–559. 5 Clifford GM, Polesel J, Rickenbach M et al.