Background. HIV infection has reached epidemic proportions in South Africa, with an estimated prevalence of 21.5% in adults living in the province of KwaZulu-Natal. Several malignancies have been identified as part of the spectrum of immunosuppression-related manifestations of HIV infection. Very few reports, however, exist regarding the occurrence of non-AIDS-defining sarcomas in the extremities or limb girdles. Methods. A retrospective review was performed on all adult patients, between the ages of 30 and 60 years, with histologically confirmed osteosarcomas of the appendicular skeleton referred to a tertiary-level orthopaedic oncology unit. Results. Five out of the nine patients (62.5%) included in the study were found to be HIV positive. The average CD4 count of these patients was 278 (237–301)？cells/mm3, indicating advanced immunological compromise. Three of the malignancies in HIV-positive patients occurred in preexisting benign or low-grade tumours. Conclusion. A heightened index of suspicion is required in HIV patients presenting with unexplained bone and joint pain or swelling. Judicious use of appropriate radiological investigation, including magnetic resonance imaging of suspicious lesions and timely referral to an appropriate specialized orthopaedic oncology unit, is recommended. 1. Introduction The prevalence of human immunodeficiency virus (HIV) infection in Southern Africa has reached epidemic proportions. Midyear estimates published by Statistics South Africa estimates the national prevalence of HIV infection in adults at 10.6% [1]. In the province of KwaZulu-Natal the situation is worse, with an estimated 21.5% of resident adults between the ages of 15 and 49 years being infected with HIV [2]. Several malignancies have been identified as part of the spectrum of immunosuppression-related manifestations of HIV infection. Principle amongst these is the AIDS-defining cancers, including Kaposi Sarcoma, non-Hodgkin’s lymphoma, and cervical cancer. Several long-term studies have indicated an increased risk for the development of a multitude of non-AIDS-defining cancers in HIV/AIDS patients [3–10]. These comprehensive long-term follow-up studies rarely mention the occurrence of bone and soft tissue tumours and also fail to describe the histological nature and site of these malignancies. The increased incidence of EBV-associated smooth muscle tumours, in patients living with HIV, has previously been described [11]. Most of these tumours were, however, found in the trunk, head, or neck. Very few reports exist on the occurrence of
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