Which One Is Better: AIDS Related or HIV Associated?

TO THE EDITOR: We have read the article by Francois Boue et al on AIDS-related lymphoma. The authors stated that rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) is a simple and effective schedule for HIV-associated lymphoma. The authors used the terms HIV-associated and AIDS-related interchangeably throughout their article. Although everybody who read it surely understood that they are more or less the same entity, it is crucial to use the most correct terminology for scientific communication, in our point of view. Which one defines malignancies developing in individuals infected with HIV better? We have some comments. Caused by HIV, AIDS is the profound immunodeficiency state characterized by opportunistic infections and Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and cervical cancer—the AIDS-defining cancers. By definition, when they are diagnosed in a patient infected with CD4 count less than 200 cells/uL that patient has AIDS. Therefore, the term AIDS-related seems better suited for AIDS-defining cancers. However, non–AIDS-defining cancers do occur in individuals infected with HIV. Several population-based studies indicated that relative risks for such malignancies with the exception of anal cancer is minimally increased during the pre-AIDS period, meaning that HIV positivity does not substantially increase risk of malignancy before inducing AIDS. Therefore, the term AIDS related seems more correct for non–AIDS-defining cancers, as well. Furthermore, highly active antiretroviral therapy prevents immunodeficiency and decreased incidences of malignancies, but can not eradicate HIV. This observation means that AIDS is necessary for the development of most cancers. In conclusion, we kindly suggest that AIDS related be preferred over HIV associated when referring to all malignancies in individuals with HIV infection.