Gliomas and brain lymphomas in HIV-1/AIDS patients: reflections from a 20-year follow up in Mexico and Brazil

Opportunistic infections and invasive primary tumors represent major causes of morbidity and mortality in HIV-1-infected individuals. HIV-1 involvement of the central nervous system (CNS) affects nearly half of seropositive patients, being the primary CNS lymphoma (PCNSL) a hallmark neoplasia of this population. Interestingly, the incidence of other brain tumors (e.g. gliomas) is exceedingly rare in AIDS patients, and their co-morbidity has been limited to case reports. Here, we share our 20-year experience following brain tumors in HIV-1/AIDS patients from major referral hospitals in Mexico and Brazil. Additionally, we provide the most updated compilation of reported glioma cases in AIDS patients, with a thorough epidemiological analysis. Furthermore, we discuss HIV-1-driven mechanisms that would theoretically increase malignant transformation of glial cells; while offering newly reported explanations as to why protease inhibitors, key components of multi-drug anti-retroviral schemes, may be responsible for such a low co-incidence of gliomas in HIV-1 infected individuals.