Epstein-Barr Virus or EBV reactivation is common in HIV+ and other immunosuppressed patients. EBV infection of B-cells can result in non-Hodgkins lymphomas such as Burkitt's lymphoma and diffuse large B cell lymphoma.
Non-Hodgkins lymphomas (NHL) comprise 60% of all lymphomas. Most are B-cell lymphomas (rather than T-cell), and one-third arise from outside of lymph nodes (e.g. from MALT). Approximately two-thirds of patients survive 5 years. Types of B-cell NHL include follicular (most common), Burkitt's, diffuse large B-cell, extranodal marginal zone, small lymphocytic, and mantle cell (rarest).
Chu et al. note that common complications in HIV patients include malignant neoplasms of the nervous system, lungs, blood, and GI tract, including CNS lymphoma, Kaposi's sarcoma, multiple myeloma, and HPV-related malignancies, respectively. Kaposi's sarcoma may also appear as an isolated skin malignancy.
Knowles reviews HIV-associated NHL reporting that the incidence of NHL is higher in HIV-infected individuals. It is noted that malignant lymphoma is the second most common neoplasm associated with AIDS. In this patient population, the vast majority of neoplasms are clinically aggressive, monoclonal B-cell neoplasms that exhibit Burkitt's, immunoblastic, large cell, or transitional histopathology.
Illustration A depicts the life cycle and infectious process of Epstein-Barr Virus (EBV).
Answer 1: HIV+ patients are at increased risk of P. jiroveci pneumonia (PCP) but this infection is not associated with an increased risk of malignancy.
Answer 2: HHV-6 causes roseola in infants. HHV-8 is the cause of Kaposi's sarcoma, a malignancy commonly seen in HIV+ patients.
Answer 3: Actinomyces israelii causes eroding abscesses of the mouth or GI tract. It is not associated with malignancies in HIV.
Answer 4: H. pylori infection is associated with an increased risk of gastric adenocarcinoma and MALToma, but this risk is not known to be affected by HIV status.
Chu and Selwyn. Am Fam Physician. 2011 Feb 15;83(4):395-406.
PMID:20507048 (Link to Abstract)
Knowles DM. Etiology and pathogenesis of AIDS-related non-Hodgkin's lymphoma. Hematol Oncol Clin North Am. 2003 Jun;17(3):785-820. Review.
PMID:12852656 (Link to Abstract)
USMLE World Step 1 QBank Question #1724. Copyright © USMLEWorld, LLC 2012