simply reflecting the now aging cohort of HIV-infected persons benefiting from HIV therapy or growing at an increased rate caused by HIV infection and immune deficiency or inflammation or even as an adverse effect of antiretroviral drugs. The standardized incidence rate for all non-AIDS–defining cancers is about twice that of the general population, although this is an area of active, ongoing investigation (Powles et al., 2009; Shiels et al., 2009).

The most common non-AIDS–defining cancers include cancers of the anus, liver, lung, oropharynx, and Hodgkin’s lymphoma (Nguyen et al., 2010; Patel et al., 2008; Powles et al., 2009). Generally, the severity of these cancers is not increased as a result of HIV coinfection and they respond comparably to chemotherapeutic management. One exception is Hodgkin’s lymphoma, which may be more aggressive in HIV/AIDS patients (Powles et al., 2009). The risk factors for these cancers depend on the type of malignancy. For example, smoking is a major risk factor for lung cancer, both in the general population and in the HIV-positive population; this can be attributed in part to higher smoking rates in the HIV-positive population and longer duration of tobacco exposure (Nguyen et al., 2010). Interestingly, most cancers that appear to have an increased incidence in HIV-infected persons have a second viral infection as a potential cause, including oropharyngeal cancer (Epstein-Barr virus), anal cancer (human papillomavirus), and hepatocellular cancer (HBV, HCV).

The effect of combination antiretroviral therapy on the increased risk of non-AIDS–defining cancers is unclear. Nonnucleoside reverse transcriptase inhibitors may be associated with an increased risk of Hodgkin’s lymphoma (Powles et al., 2009), and an increase in cancer was reported with an early CCR5 inhibitor, but the literature is limited about the effects of specific classes of antiretroviral therapy on developing malignancies. Combination antiretroviral therapy may improve survival for some types of cancers, but this is not yet well supported in the literature (Nguyen et al., 2010).

Malignancies not otherwise specified in this report can be disabling and are important to consider in the management of HIV/AIDS. These malignancies are generally not unique from malignancies in noninfected individuals. These conditions follow the same standard treatment regimens as in the general population. Therefore, the committee concludes that malignancies should be considered under the Malignant Neoplastic Diseases Listings (13.00 and 113.00).

COMORBIDITY IN THE LISTINGS

SSA has specific processes in place to deal with claimants affected by multiple conditions. A process called cross-referencing can be used at the Listings step, where the claim is “referred” to an existing listing and the



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