Merkel Cell Carcinoma in the HIV-1/AIDS Patient

  • Robert H. Goldstein
  • James A. DeCaprioEmail author
Part of the Cancer Treatment and Research book series (CTAR, volume 177)


Merkel cell carcinoma (MCC) is a highly aggressive, primary neuroendocrine cancer of the skin. The majority of MCC cases are associated with the recently discovered Merkel cell polyomavirus (MCPyV), while the remaining are caused by ultraviolet (UV) light-induced mutations from excessive sunlight exposure. The risk of developing MCC is much higher in the white population relative to all other races. Approximately 10% of all patients with MCC have some form of immunosuppression including HIV-1/AIDS, chronic inflammatory conditions, solid organ transplantation, or hematological malignancies. The age of onset of MCC is lower and the mortality is higher in immunosuppressed individuals than in immune-competent patients. It is plausible that HIV-1/AIDS predisposes to virus-positive MCC, but it should be noted that HIV-1/AIDS increases the risk for developing of UV-induced skin cancers such as cutaneous squamous cell carcinoma and basal cell carcinoma and therefore may also increase the risk for virus-negative MCC. Surgical management is considered standard of care for localized Merkel cell carcinoma with current recommendations advising a wide local excision of the lesion. Most international guidelines support the use of local adjuvant radiotherapy coupled with tumor staging to improve the frequency of cure. For advanced, metastatic, and recurrent MCC, checkpoint blockade inhibitors targeting PD-1 and PD-L1 have shown remarkable activity including durable long-term. MCC in patients living with HIV-1/AIDS are treated with similar modalities as HIV-1 uninfected individuals with MCC.



This work was supported in part by U.S. Public Health Service grants R01CA63113, R01CA173023, and P01CA050661 and the DFCI Helen Pappas Merkel Cell Research Fund and the Claudia Adams Barr Program in Cancer Research to J.A.D.


  1. 1.
    Paulson KG et al (2017) Merkel cell carcinoma: current United States incidence and projected increases based on changing demographics. J Am Acad DermatolGoogle Scholar
  2. 2.
    Toker C (1972) Trabecular carcinoma of the skin. Arch Dermatol 105(1):107–110CrossRefPubMedGoogle Scholar
  3. 3.
    Tang CK, Toker C (1978) Trabecular carcinoma of the skin: an ultrastructural study. Cancer 42(5):2311–2321CrossRefPubMedGoogle Scholar
  4. 4.
    Toker C (1982) Trabecular carcinoma of the skin. A question of title. Am J Dermatopathol 4(6):497–500CrossRefPubMedGoogle Scholar
  5. 5.
    Rywlin AM (1982) Malignant Merkel-cell tumor is a more accurate description than trabecular carcinoma. Am J Dermatopathol 4(6):513–515CrossRefPubMedGoogle Scholar
  6. 6.
    Maksimovic S et al (2014) Epidermal Merkel cells are mechanosensory cells that tune mammalian touch receptors. Nature 509(7502):617–621CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Agelli M et al (2010) The etiology and epidemiology of Merkel cell carcinoma. Curr Probl Cancer 34(1):14–37CrossRefPubMedGoogle Scholar
  8. 8.
    Misch D et al (2015) Value of thyroid transcription factor (TTF)-1 for diagnosis and prognosis of patients with locally advanced or metastatic small cell lung cancer. Diagn Pathol 10:21CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Pulitzer MP et al (2015) Cutaneous squamous and neuroendocrine carcinoma: genetically and immunohistochemically different from Merkel cell carcinoma. Mod Pathol 28(8):1023–1032CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Pitale M, Sessions RB, Husain S (1992) An analysis of prognostic factors in cutaneous neuroendocrine carcinoma. Laryngoscope 102(3):244–249CrossRefPubMedGoogle Scholar
  11. 11.
    Gooptu C et al (1997) Merkel cell carcinoma arising after therapeutic immunosuppression. Br J Dermatol 137(4):637–641CrossRefPubMedGoogle Scholar
  12. 12.
    Centers for Disease, Control and Prevention (1997) Update: trends in AIDS incidence, deaths, and prevalence–United States, 1996. MMWR Morb Mortal Wkly Rep 46(8):165–173Google Scholar
  13. 13.
    Catlett JP, Todd WM, Carr ME Jr (1992) Merkel cell tumor in an HIV-positive patient. Va Med Q 119(4):256–258PubMedGoogle Scholar
  14. 14.
    Engels EA et al (2002) Merkel cell carcinoma and HIV infection. Lancet 359(9305):497–498CrossRefPubMedGoogle Scholar
  15. 15.
    Cone LA et al (2006) Merkel cell carcinoma in an HIV-1-infected man. AIDS 20(3):474–475CrossRefPubMedGoogle Scholar
  16. 16.
    Manganoni MA et al (2007) Merkel cell carcinoma and HIV infection: a case report and review of the literature. AIDS Patient Care STDS 21(7):447–451CrossRefPubMedGoogle Scholar
  17. 17.
    Busse PM et al (2008) Case records of the Massachusetts general hospital. Case 19-2008. A 63-year-old HIV-positive man with cutaneous Merkel-cell carcinoma. N Engl J Med 358(25):2717–2723CrossRefPubMedGoogle Scholar
  18. 18.
    Ottaviani F et al (2010) Bona fide primary Merkel cell carcinoma of an intraparotid lymph node in a HIV-positive patient. Int J Surg Pathol 18(5):406–408CrossRefPubMedGoogle Scholar
  19. 19.
    Izikson L et al (2011) Merkel cell carcinoma associated with HIV: review of 14 patients. AIDS 25(1):119–121CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Wieland U, Kreuter A (2011) Merkel cell polyomavirus infection and Merkel cell carcinoma in HIV-positive individuals. Curr Opin Oncol 23(5):488–493CrossRefPubMedGoogle Scholar
  21. 21.
    Li M et al (2013) Metastatic Merkel cell carcinoma of the oral cavity in a human immunodeficiency virus-positive patient and the detection of Merkel cell polyomavirus. Oral Surg Oral Med Oral Pathol Oral Radiol 115(5):e66–e71CrossRefPubMedGoogle Scholar
  22. 22.
    Samarendra P et al (2000) Primary nodal neuroendocrine (Merkel cell) tumor in a patient with HIV infection. South Med J 93(9):920–922CrossRefPubMedGoogle Scholar
  23. 23.
    Heath M et al (2008) Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. J Am Acad Dermatol 58(3):375–381CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lanoy E, Engels EA (2010) Skin cancers associated with autoimmune conditions among elderly adults. Br J Cancer 103(1):112–114CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Clarke CA et al (2015) Risk of Merkel cell carcinoma after solid organ transplantation. J Natl Cancer Inst 107(2)CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Sahi H et al (2017) History of chronic inflammatory disorders increases the risk of Merkel cell carcinoma, but does not correlate with Merkel cell polyomavirus infection. Br J Cancer 116(2):260–264CrossRefPubMedGoogle Scholar
  27. 27.
    Bichakjian CK et al (2018) Merkel cell carcinoma, Version 1.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 16(6):742–774Google Scholar
  28. 28.
    Bhatia S et al (2016) Adjuvant radiation therapy and chemotherapy in Merkel cell carcinoma: survival analyses of 6908 cases from the national cancer data base. J Natl Cancer Inst 108(9)CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Paulson KG et al (2013) Systemic immune suppression predicts diminished Merkel cell carcinoma-specific survival independent of stage. J Invest Dermatol 133(3):642–646CrossRefPubMedGoogle Scholar
  30. 30.
    Albores-Saavedra J et al (2010) Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. J Cutan Pathol 37(1):20–27CrossRefPubMedGoogle Scholar
  31. 31.
    Howard RA et al (2006) Merkel cell carcinoma and multiple primary cancers. Cancer Epidemiol Biomark Prev 15(8):1545–1549CrossRefGoogle Scholar
  32. 32.
    Feng H et al (2008) Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science 319(5866):1096–1100CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Durst M et al (1983) A papillomavirus DNA from a cervical carcinoma and its prevalence in cancer biopsy samples from different geographic regions. Proc Natl Acad Sci USA 80(12):3812–3815CrossRefPubMedGoogle Scholar
  34. 34.
    Chang Y et al (1994) Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi’s sarcoma. Science 266(5192):1865–1869CrossRefPubMedGoogle Scholar
  35. 35.
    Tolstov YL et al (2011) Asymptomatic primary Merkel cell polyomavirus infection among adults. Emerg Infect Dis 17(8):1371–1380CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    DeCaprio JA, Garcea RL (2013) A cornucopia of human polyomaviruses. Nat Rev Microbiol 11(4):264–276CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    DeCaprio JA (2017) Merkel cell polyomavirus and Merkel cell carcinoma. Philos Trans R Soc Lond B Biol Sci 372(1732)CrossRefGoogle Scholar
  38. 38.
    Gross L (1953) A filterable agent, recovered from Ak leukemic extracts, causing salivary gland carcinomas in C3H mice. Proc Soc Exp Biol Med 83(2):414–421CrossRefPubMedGoogle Scholar
  39. 39.
    Buck CB et al (2016) The ancient evolutionary history of polyomaviruses. PLoS Pathog 12(4):e1005574CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Gheit T et al (2017) Isolation and characterization of a novel putative human polyomavirus. Virology 506:45–54CrossRefPubMedGoogle Scholar
  41. 41.
    Carter JJ et al (2013) Identification of an overprinting gene in Merkel cell polyomavirus provides evolutionary insight into the birth of viral genes. Proc Natl Acad Sci U S A 110(31):12744–12749CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Schowalter RM, Buck CB (2013) The Merkel cell polyomavirus minor capsid protein. PLoS Pathog 9(8):e1003558CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Gardner SD et al (1971) New human papovavirus (B.K.) isolated from urine after renal transplantation. Lancet 1(7712):1253–1257CrossRefGoogle Scholar
  44. 44.
    Barouch DH et al (2002) BK virus-associated hemorrhagic cystitis in a human immunodeficiency virus-infected patient. Clin Infect Dis 35(3):326–329CrossRefPubMedGoogle Scholar
  45. 45.
    Knowles WA et al (2003) Population-based study of antibody to the human polyomaviruses BKV and JCV and the simian polyomavirus SV40. J Med Virol 71(1):115–123CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Ambalathingal GR et al (2017) BK polyomavirus: clinical aspects, immune regulation, and emerging therapies. Clin Microbiol Rev 30(2):503–528CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    van Aalderen MC et al (2012) BK virus infection in transplant recipients: clinical manifestations, treatment options and the immune response. Neth J Med 70(4):172–183PubMedGoogle Scholar
  48. 48.
    Erard V et al (2004) BK virus infection in hematopoietic stem cell transplant recipients: frequency, risk factors, and association with postengraftment hemorrhagic cystitis. Clin Infect Dis 39(12):1861–1865CrossRefPubMedGoogle Scholar
  49. 49.
    Ramos E et al (2009) The decade of polyomavirus BK-associated nephropathy: state of affairs. Transplantation 87(5):621–630CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Bratt G et al (1999) BK virus as the cause of meningoencephalitis, retinitis and nephritis in a patient with AIDS. AIDS 13(9):1071–1075CrossRefPubMedGoogle Scholar
  51. 51.
    Ledesma J et al (2012) BK virus infection in human immunodeficiency virus-infected patients. Eur J Clin Microbiol Infect Dis 31(7):1531–1535CrossRefPubMedGoogle Scholar
  52. 52.
    Antoniolli L, Borges R, Goldani LZ (2017) BK virus encephalitis in HIV-infected patients: case report and review. Case Rep Med 2017:4307468CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Padgett BL et al (1971) Cultivation of papova-like virus from human brain with progressive multifocal leucoencephalopathy. Lancet 1(7712):1257–1260CrossRefPubMedGoogle Scholar
  54. 54.
    Tan CS et al (2012) Increased program cell death-1 expression on T lymphocytes of patients with progressive multifocal leukoencephalopathy. J Acquir Immune Defic Syndr 60(3):244–248CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Major EO (2010) Progressive multifocal leukoencephalopathy in patients on immunomodulatory therapies. Annu Rev Med 61:35–47CrossRefPubMedGoogle Scholar
  56. 56.
    Bowen LN et al (2016) HIV-associated opportunistic CNS infections: pathophysiology, diagnosis and treatment. Nat Rev Neurol 12(11):662–674CrossRefPubMedGoogle Scholar
  57. 57.
    Cinque P et al (2009) Progressive multifocal leukoencephalopathy in HIV-1 infection. Lancet Infect Dis 9(10):625–636CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Schowalter RM et al (2010) Merkel cell polyomavirus and two previously unknown polyomaviruses are chronically shed from human skin. Cell Host Microbe 7(6):509–515CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    van der Meijden E et al (2010) Discovery of a new human polyomavirus associated with trichodysplasia spinulosa in an immunocompromized patient. PLoS Pathog 6(7):e1001024CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Nguyen KD et al (2016) Human polyomavirus 6 and 7 are associated with pruritic and dyskeratotic dermatoses. J Am Acad DermatolGoogle Scholar
  61. 61.
    van der Meijden E et al (2016) Primary polyomavirus infection, not reactivation, as the cause of trichodysplasia spinulosa in immunocompromised patients. J Infect DisGoogle Scholar
  62. 62.
    Liu W et al (2016) Identifying the target cells and mechanisms of Merkel cell polyomavirus infection. Cell Host Microbe 19(6):775–787CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Hurdiss DL et al (2016) New structural insights into the genome and minor capsid proteins of BK polyomavirus using cryo-electron microscopy. Structure 24(4):528–536CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Chromy LR, Pipas JM, Garcea RL (2003) Chaperone-mediated in vitro assembly of polyomavirus capsids. Proc Natl Acad Sci U S A 100(18):10477–10482CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Norkiene M et al (2015) Production of recombinant VP1-derived virus-like particles from novel human polyomaviruses in yeast. BMC Biotechnol 15:68CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Martel-Jantin C et al (2013) Merkel cell polyomavirus infection occurs during early childhood and is transmitted between siblings. J Clin Virol 58(1):288–291CrossRefPubMedGoogle Scholar
  67. 67.
    van der Meijden E et al (2013) Different serologic behavior of MCPyV, TSPyV, HPyV6, HPyV7 and HPyV9 polyomaviruses found on the skin. PLoS ONE 8(11):e81078CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Gossai A et al (2016) Seroepidemiology of human polyomaviruses in a US population. Am J Epidemiol 183(1):61–69CrossRefPubMedGoogle Scholar
  69. 69.
    Nicol JT et al (2013) Age-specific seroprevalences of merkel cell polyomavirus, human polyomaviruses 6, 7, and 9, and trichodysplasia spinulosa-associated polyomavirus. Clin Vaccine Immunol 20(3):363–368CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Paulson KG et al (2017) Viral oncoprotein antibodies as a marker for recurrence of Merkel cell carcinoma: a prospective validation study. Cancer 123(8):1464–1474CrossRefPubMedGoogle Scholar
  71. 71.
    Pastrana DV et al (2009) Quantitation of human seroresponsiveness to Merkel cell polyomavirus. PLoS Pathog 5(9):e1000578CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Wong SQ et al (2015) UV-associated mutations underlie the etiology of MCV-negative Merkel cell carcinomas. Cancer Res 75(24):5228–5234CrossRefPubMedGoogle Scholar
  73. 73.
    Harms PW et al (2015) The distinctive mutational spectra of polyomavirus-negative Merkel cell carcinoma. Cancer Res 75(18):3720–3727CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Harms PW et al (2016) Next generation sequencing of Cytokeratin 20-negative Merkel cell carcinoma reveals ultraviolet-signature mutations and recurrent TP53 and RB1 inactivation. Mod Pathol 29(3):240–248CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Goh G et al (2016) Mutational landscape of MCPyV-positive and MCPyV-negative Merkel cell carcinomas with implications for immunotherapy. Oncotarget 7(3):3403–3415CrossRefPubMedGoogle Scholar
  76. 76.
    Starrett GJ et al (2017) Merkel cell polyomavirus exhibits dominant control of the tumor genome and transcriptome in virus-associated Merkel cell carcinoma. MBio 8(1)Google Scholar
  77. 77.
    Gonzalez-Vela MD et al (2017) Shared oncogenic pathways implicated in both virus-positive and UV-induced Merkel cell carcinomas. J Invest Dermatol 137(1):197–206CrossRefPubMedGoogle Scholar
  78. 78.
    Popp S et al (2002) UV-B-type mutations and chromosomal imbalances indicate common pathways for the development of Merkel and skin squamous cell carcinomas. Int J Cancer 99(3):352–360CrossRefPubMedGoogle Scholar
  79. 79.
    Moshiri A et al (2016) Polyomavirus-negative Merkel cell carcinoma: a more aggressive subtype based on analysis of 282 cases using multi-modal tumor virus detection. J Invest Dermatol 137(4):819–827CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Wang L et al (2017) Age and gender associations of virus positivity in Merkel cell carcinoma characterized using a novel RNA in situ hybridization assay. Clin Cancer ResGoogle Scholar
  81. 81.
    Shuda M et al (2008) T antigen mutations are a human tumor-specific signature for Merkel cell polyomavirus. Proc Natl Acad Sci U S A 105(42):16272–16277CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Cheng J et al (2013) Merkel cell polyomavirus large T antigen has growth-promoting and inhibitory activities. J Virol 87(11):6118–6126CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Li J et al (2013) Merkel cell polyomavirus large T antigen disrupts host genomic integrity and inhibits cellular proliferation. J Virol 87(16):9173–9188CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Laude HC et al (2010) Distinct Merkel cell polyomavirus molecular features in tumour and non tumour specimens from patients with Merkel cell carcinoma. PLoS Pathog 6(8)CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Nakamura T et al (2010) Nuclear localization of Merkel cell polyomavirus large T antigen in Merkel cell carcinoma. Virology 398(2):273–279CrossRefPubMedGoogle Scholar
  86. 86.
    Kwun HJ et al (2015) Restricted protein phosphatase 2A targeting by Merkel cell polyomavirus small T antigen. J Virol 89(8):4191–4200CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Kwun HJ et al (2013) Merkel cell polyomavirus small T antigen controls viral replication and oncoprotein expression by targeting the cellular ubiquitin ligase SCFFbw7. Cell Host Microbe 14(2):125–135CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Tsang SH et al (2016) The oncogenic small tumor antigen of Merkel cell polyomavirus is an iron-sulfur cluster protein that enhances viral DNA replication. J Virol 90(3):1544–1556CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Shuda M et al (2015) CDK1 substitutes for mTOR kinase to activate mitotic cap-dependent protein translation. Proc Natl Acad Sci U S A 112(19):5875–5882CrossRefPubMedPubMedCentralGoogle Scholar
  90. 90.
    Shuda M et al (2011) Human Merkel cell polyomavirus small T antigen is an oncoprotein targeting the 4E-BP1 translation regulator. J Clin Invest 121(9):3623–3634CrossRefPubMedPubMedCentralGoogle Scholar
  91. 91.
    Cheng J et al (2017) Merkel cell polyomavirus recruits MYCL to the EP400 complex to promote oncogenesis. PLoS Pathog 13(10):e1006668CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Berrios C et al (2016) Merkel cell polyomavirus small T antigen promotes pro-glycolytic metabolic perturbations required for transformation. PLoS Pathog 12(11):e1006020CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Stakaityte G et al (2018) Merkel cell polyomavirus small T antigen drives cell motility via Rho-GTPase-induced filopodium formation. J Virol 92(2)Google Scholar
  94. 94.
    Spurgeon ME et al (2015) Tumorigenic activity of Merkel cell polyomavirus T antigens expressed in the stratified epithelium of mice. Cancer Res 75(6):1068–1079CrossRefPubMedPubMedCentralGoogle Scholar
  95. 95.
    Shuda M et al (2015) Merkel cell polyomavirus small T antigen induces cancer and embryonic Merkel cell proliferation in a transgenic mouse model. PLoS ONE 10(11):e0142329CrossRefPubMedPubMedCentralGoogle Scholar
  96. 96.
    Verhaegen ME et al (2015) Merkel cell polyomavirus small T antigen is oncogenic in transgenic mice. J Invest Dermatol 135(5):1415–1424CrossRefPubMedGoogle Scholar
  97. 97.
    Bouvard V et al (2012) Carcinogenicity of malaria and of some polyomaviruses. Lancet Oncol 13(4):339–340CrossRefPubMedGoogle Scholar
  98. 98.
    Busam KJ et al (2009) Merkel cell polyomavirus expression in merkel cell carcinomas and its absence in combined tumors and pulmonary neuroendocrine carcinomas. Am J Surg Pathol 33(9):1378–1385CrossRefPubMedPubMedCentralGoogle Scholar
  99. 99.
    Kuwamoto S et al (2011) Association of Merkel cell polyomavirus infection with morphologic differences in Merkel cell carcinoma. Hum Pathol 42(5):632–640CrossRefPubMedGoogle Scholar
  100. 100.
    Martel-Jantin C et al (2014) Molecular epidemiology of merkel cell polyomavirus: evidence for geographically related variant genotypes. J Clin Microbiol 52(5):1687–1690CrossRefPubMedPubMedCentralGoogle Scholar
  101. 101.
    Dowlatshahi M et al (2013) Tumor-specific T cells in human Merkel cell carcinomas: a possible role for Tregs and T-cell exhaustion in reducing T-cell responses. J Invest Dermatol 133(7):1879–1889CrossRefPubMedPubMedCentralGoogle Scholar
  102. 102.
    Mogha A et al (2010) Merkel cell polyomavirus small T antigen mRNA level is increased following in vivo UV-radiation. PLoS ONE 5(7):e11423CrossRefPubMedPubMedCentralGoogle Scholar
  103. 103.
    Engels EA et al (2002) Prevalence of hepatitis C virus infection and risk for hepatocellular carcinoma and non-Hodgkin lymphoma in AIDS. J Acquir Immune Defic Syndr 31(5):536–541CrossRefPubMedGoogle Scholar
  104. 104.
    McGovern BH (2007) The epidemiology, natural history and prevention of hepatitis B: implications of HIV coinfection. Antivir Ther 12(Suppl 3):H3–H13PubMedGoogle Scholar
  105. 105.
    Wieland U et al (2011) Merkel cell polyomavirus infection in HIV-positive men. Arch Dermatol 147(4):401–406CrossRefPubMedGoogle Scholar
  106. 106.
    Asgari MM et al (2017) Association of multiple primary skin cancers with human immunodeficiency virus infection, CD4 count, and viral load. JAMA Dermatol 153(9):892–896CrossRefPubMedPubMedCentralGoogle Scholar
  107. 107.
    Silverberg MJ et al (2013) HIV infection status, immunodeficiency, and the incidence of non-melanoma skin cancer. J Natl Cancer Inst 105(5):350–360CrossRefPubMedPubMedCentralGoogle Scholar
  108. 108.
    Chang AY, Doiron P, Maurer T (2017) Cutaneous malignancies in HIV. Curr Opin HIV AIDS 12(1):57–62CrossRefPubMedGoogle Scholar
  109. 109.
    Nehal KS, Bichakjian CK (2018) Update on Keratinocyte Carcinomas. N Engl J Med 379(4):363–374CrossRefPubMedGoogle Scholar
  110. 110.
    Garrett GL et al (2017) Incidence of and risk factors for skin cancer in organ transplant recipients in the United States. JAMA Dermatol 153(3):296–303CrossRefPubMedGoogle Scholar
  111. 111.
    Wheless L et al (2014) Skin cancer in organ transplant recipients: more than the immune system. J Am Acad Dermatol 71(2):359–365CrossRefPubMedPubMedCentralGoogle Scholar
  112. 112.
    Scott FI et al (2016) Risk of nonmelanoma skin cancer associated with the use of immunosuppressant and biologic agents in patients with a history of autoimmune disease and nonmelanoma skin cancer. JAMA Dermatol 152(2):164–172CrossRefPubMedPubMedCentralGoogle Scholar
  113. 113.
    Nghiem PT et al (2016) PD-1 blockade with pembrolizumab in advanced Merkel-cell carcinoma. N Engl J Med 374(26):2542–2552CrossRefPubMedPubMedCentralGoogle Scholar
  114. 114.
    Kaufman HL et al (2016) Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial. Lancet Oncol 17(10):1374–1385CrossRefPubMedPubMedCentralGoogle Scholar
  115. 115.
    Montoto S et al (2012) HIV status does not influence outcome in patients with classical Hodgkin lymphoma treated with chemotherapy using doxorubicin, bleomycin, vinblastine, and dacarbazine in the highly active antiretroviral therapy era. J Clin Oncol 30(33):4111–4116CrossRefPubMedPubMedCentralGoogle Scholar
  116. 116.
    Little RF, Dunleavy K (2013) Update on the treatment of HIV-associated hematologic malignancies. Hematol Am Soc Hematol Educ Program 2013:382–388CrossRefGoogle Scholar
  117. 117.
    Davar D et al (2015) PD-1 blockade in advanced melanoma in patients with Hepatitis C and/or HIV. Case Rep Oncol Med 2015:737389PubMedPubMedCentralGoogle Scholar
  118. 118.
    Lavole A et al (2018) PD-1 blockade in HIV-infected patients with lung cancer: a new challenge or already a strategy? Ann Oncol 29(4):1065–1066CrossRefPubMedGoogle Scholar
  119. 119.
    Ostios-Garcia L et al (2018) Safety and efficacy of PD-1 inhibitors among HIV-positive patients with non-small cell lung cancer. J Thorac Oncol 13(7):1037–1042CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Infectious Disease, Department of MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of Medical OncologyDana-Farber Cancer InstituteBostonUSA
  3. 3.Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA

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