What are the guideline sources, guidelines and references for HIV-associated malignancies ?
Guideline 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 Calculator Calculator Eastern Cooperative Oncology G Karnofsky performance status s 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 https://web.pathway.md/diseases/recwxqzfYkJIRiFly 1/4 6/24/23, 12:31 PM HIV-associated malignancies Pathway Evaluation for Castleman's disease: consider obtaining histological confirmation by immunocytochemical staining for HHV-8 and IgM lambda. C Evaluation for anal cancer: perform examination under anesthetic of the anal canal and rectum with biopsy in all suspected cases. B 2. Medical management Highly active antiretroviral therapy: initiate HAART in all patients diagnosed with Kaposi sarcoma. B Irradiation of blood products: use irradiated blood products for patients with human immunodeficiency virus infection and Hodgkin's lymphoma who require blood products. B 3. Specific circumstances Patients with Kaposi's sarcoma: initiate chemotherapy along with HAART for patients with T1 advanced stage Kaposi's sarcoma. B Show 3 more Patients with Hodgkin's lymphoma: administer doxorubicin, bleomycin, vinblastine, and dacarbazine 2-4 + involved field radiation therapy 20-30 Gy for early-favorable Hodgkin's lymphoma. B Patients with diffuse large-B cell lymphoma: administer chemotherapy regimens (such as CHOP or EPOCH) used in human immunodeficiency virus-negative patients for first-line treatment of diffuse large-B cell lymphoma in human immunodeficiency virus-positive patients. B Show 3 more Patients with Burkitt's lymphoma: administer first-line treatment of Burkitt's lymphoma in human immunodeficiency virus-infected individuals with regimens such as cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate, alternating with ifosfamide, etoposide, and cytarabine (CODOX-M/IVAC) and dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH). B Patients with multicentric Castleman's disease: administer rituximab as the first-line treatment for multicentric Castleman's disease. B Patients with primary central nervous system lymphoma: place all patients with primary CNS lymphoma on HAART if not already on it. B Patients with primary effusion lymphoma: consider offering first-line treatment of primary effusion lymphoma in human immunodeficiency virus-infected individuals with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-like regimens. No comparative studies have been performed and there is no optimal gold-standard therapy. C Patients with plasmablastic lymphoma: initiate HAART with systemic anthracycline-containing chemotherapy as first-line therapy for patients with plasmablastic lymphoma. B https://web.pathway.md/diseases/recwxqzfYkJIRiFly 2/4 6/24/23, 12:31 PM HIV-associated malignancies Pathway Patients with relapsed/refractory aggressive lymphoma: administer a second-line chemotherapy regimen (level of evidence 1C), which may contain platinum, to patients deemed fit for intensive chemotherapy with relapsed/refractory aggressive AIDS-related lymphoma. B Patients with anal cancer: administer chemoradiotherapy with 5-fluorouracil and mitomycin C. A Patients with cervical intraepithelial neoplasia and cervical cancer: advise all women newly diagnosed with human immunodeficiency virus to have cervical surveillance performed by, or in conjunction with, the medical team managing their human immunodeficiency virus infection (level of evidence 1B). Perform an initial colposcopy and annual cytology if resources permit. B Patients with non-AIDS-defining malignancies: consider treating germ cell tumours of the testis in an identical manner regardless of human immunodeficiency virus status. C 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 Prophylaxis against opportunistic infections: initiate prophylaxis against P. jirovecii pneumonia in patients with HIV and a CD4 cell count < 200 cells/uL. A 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 Consideration for enrolment in clinical trials: screen all patients for enrolment in clinical trials, if appropriate. B Monitoring for patients with Hodgkin's lymphoma: perform assessment of response after treatment bypositron emission tomography scan and bone marrow biopsy. B Monitoring for patients with multicentric Castleman's disease: consider a rise in plasma HHV8 level to be predictive of relapse. C References 1. Bower M, Palfreeman A, Alfa-Wali M et al. British HIV Association guidelines for HIV-associated malignancies 2014. HIV Med. 2014 Mar;15 Suppl 2 1 92. Open 2. Robert Yarchoan, Thomas S Uldrick. HIV Associated Cancers and Related Diseases. N Engl J Med. 2018 Mar 15;378 11 1029 1041. Open https://web.pathway.md/diseases/recwxqzfYkJIRiFly 3/4 6/24/23, 12:31 PM HIV-associated malignancies Pathway 3. Edgar P Simard, Ruth M Pfeiffer, Eric A Engels. Mortality due to cancer among people with AIDS a novel approach using registry-linkage data and population attributable risk methods. AIDS. 2012 Jun 19;26 10 1311 8. Open https://web.pathway.md/diseases/recwxqzfYkJIRiFly 4/4