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To study the cancer pattern among HIV positive cancer cases. The study group included patients registered in the HIV Cancer clinic at the Tata Memorial Hospital (TMH), Mumbai, which is the largest tertiary referral cancer center in India. We used the gender and age-specific proportions of each cancer site of the year 2002 that was recorded in the Hospital Cancer Registry to estimate an expected number of various cancer sites among HIV positive cancer patients during the period 2001–2005. The observed number of site-specific cancer cases was divided by the expected number to obtain proportional incidence ratio (PIR). No case of Kaposi’s sarcoma was observed. Increased proportion of non- Hodgkin’s lymphoma (NHL) was observed (PIR in males = 17.1, 95%CI 13.33-21.84, females = 10.3, 95%CI 6.10-17.41).In males, PIR was increased for anal cancer (PIR = 10.3, 95%CI 4.30–24.83), Hodgkin’s disease, testicular cancer, colon cancer, and few head and neck cancer sites. Among females, the PIRs for cervical cancer (PIR = 4.1, 95%CI 2.90–5.75), vaginal cancer (PIR = 7.7, 95%CI 2.48–23.85), and anal cancer (PIR = 6.5, 95%CI 0.91–45.88) were increased. The absence of Kaposi’s sarcoma and increased PIRs for certain non –AIDS defining cancers among HIV infected cancer cases indicates a different spectrum of HIV associated malignancies in this region. The raised PIR for cervical cancer emphasizes the urgent need for screening programs for cervical cancer among HIV infected individuals in India.

Background Infection with human immunodeficiency virus infection (HIV) is associated with an increased risk of Non Hodgkin’s lymphoma (NHL). There is limited data on the treatment and outcome of these lymphomas in India. We describe a retrospective study of 277 HIV infected patients with NHL at a tertiary referral cancer center in Mumbai. Material and methods All patients included in this study were registered at the HIV cancer clinic of the hospital during 2001-2010. All patients were diagnosed to have NHL by tissue biopsy and were confirmed by immunohistochemical tests. Patients were staged with the Ann Arbor staging system. Data of their demographic profiles, immune status, NHL stage, treatment received, response and outcomes were analyzed. We used the gender and age-specific proportion of NHL of the year 2002 that was recorded in the Hospital Cancer Registry to estimate an expected number of NHL among HIV positive cancer patients during the period 2001-2010 (n=770) and the proportional incidence ratio (PIR) was calculated. Results There were 277 patients during the ten year study period. In males the PIR for NHL was 12.6 (95% CI 1.2-14.6) and in females it was 22.1 (95%CI 17.1-28.3) .Among the 277 patients there were 69 females (24.9%) and 208 males (75.1%). The median age of males was 38 years. In females the median age was 37 years.100 Patients (36.1%) were previously known to be HIV positive(range 6 mths-15 years).The CD4 count was less than 200 per cumm in 127/192 (66.14%) patients.76/277 (27.43% ) had current or past history of tuberculosis. 172/277 (62%) patients had extranodal involvement. 168/277 (60.64%) received cancer directed treatment . The data of the 168 patients who received treatment was analyzed. 91/134 (67.91%) had CD4 counts less than 200. 115/168 (68.45%) received antiretroviral therapy. 60% had extranodal involvement.72 (42.9%) had DLCL, 42 (25%) plasmablastic, 21(12.5%) Burkitt’s type and 31 (18.5%) others.90/168 (53.6%) had advanced disease at presentation. All patients were treated with chemotherapy. 54 patients also received RT. The response was evaluated in 96 patients. There was complete response in 46 (47.9%), partial in 15 (15.6%), stable in 6 (6.3%) and 29 (30.2%) patients had progressive disease. The median survival was 25.3 months (range 0-56 months). ART affected survival significantly; however age, sex, CD4 counts at presentation, histopathology, and presence of extranodal involvement and stage of disease did not affect the survival. Conclusions In our study the PIR for NHL was high in HIV-infected patients. The proportion of plasmablastic lymphomas is high. The use of antiretroviral therapy has impacted the overall survival.

PURPOSE OF REVIEW: India has the second largest number of HIV/AIDS patients in the world; however studies done in the area of HIV-related malignancies are few. With the availability of highly active antiretroviral therapy and treatment and prevention of opportunistic infections an increase in life expectancy of HIV-infected individuals and an increase in HIV-related malignancies is expected. The purpose of this review is to put forth the Indian scenario of HIV-related malignancies. RECENT FINDINGS: About 2.5 million Indians have HIV/AIDS. Non-Hodgkins lymphoma and cervical cancer were found to occur in a higher proportion among the HIV-infected individuals in India as compared with non-HIV-infected individuals. The incidence of AIDS-related primary central nervous system lymphoma is low in India. Kaposis sarcoma is rare in India. Amongst the non-AIDS defining cancers anal cancer testicular cancer Hodgkins disease colon cancer and certain head and neck cancer sites in men and vaginal cancers among women were found to occur more frequently. SUMMARY: With the availability of highly active antiretroviral therapy an increased mortality and morbidity due to neoplastic diseases is expected in the future. As India is a large country and geographically and culturally diverse large-scale studies need to be done linking the regional cancer centres with the AIDS centres across the country to evaluate the exact burden of HIV-related malignancies.

Methods An observational study was done of pediatric patients diagnosed with cancer and who were HIV-infected at the Tata Memorial Cancer Hospital, a tertiary referral cancer centre in Mumbai, India. The study period was 2001 to 2007. Data regarding demographic profiles, types of cancers, stage of cancer, treatment and outcome, immune status was analyzed. We used gender and age-specific proportions of pediatric cancer which were recorded in the Tata Hospital cancer registry in 2002 to estimate an expected number of pediatric cancers among HIV positive pediatric cancer patients during the 2001 to 2007. The proportional incidence ratio (PIR) was calculated.