Special Considerations Regarding Antiretroviral Therapy and Infection Prophylaxis in the HIV-Infected Individual with Cancer

  • Joseph A. Sparano
  • Gary Kalkut
Part of the Cancer Treatment and Research book series (CTAR, volume 104)


The survival of patients with HIV infection has improved substantially, especially within the past four years.1 2 3 Factors that initially led to this improvement included improved prophylaxis of opportunistic infections, especiallyPneumocystis cariniipneumonia (PCP), and improved recognition and management of other opportunistic infections. Although PCP prophylaxis led to a reduction in deaths due to PCP, it was also associated with an increased risk of wasting syndrome, esophageal candidiasis, and infection with atypical mycobacteria and cytomegalovirus. 4 Physician experience is also an important factor that influences prognosis, undoubtedly due to appropriate use of infection prophylaxis, early recognition and management of infections, and other factors. 5 Prior to 1996, antiretroviral therapy that consisted of single agent nucleoside analogues had only a modest influence on survival. 6 Beginning in 1996, however, antiretroviral therapy began to have a profound effect on survival. It was during this year that the protease inhibitors became available for clinical use. It became common practice to use protease inhibitors in combination with two nucleoside analogues in order to maximally reduce viral burden, a treatment strategy that became known as “highly active antiretroviral therapy”, or HAART. 7 8 This practice led to as substantial reduction in morbidity and mortality secondary to HIV infection in the United States in 1996 and 1997 compared with 1995. 3 Several reports have also suggested a lower incidence of lymphoma and Kaposi’s sarcoma since the introduction of protease inhibitors and HAART9 10 11 12 13, although this effect has not been consistently observed by all groups. 14 15 16


Primary Central Nervous System Lymphoma Pneumocystis Carinii Pneumonia Vinca Alkaloid Infection Prophylaxis Esophageal Candidiasis 
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Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Joseph A. Sparano
    • 1
  • Gary Kalkut
    • 1
  1. 1.Albert Einstein College of MedicineMontefiore Medical Center, Albert Einstein Comprehensive Cancer CenterUSA

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