HIV and Cancer

People infected with HIV have a substantially higher risk of some types of cancer compared with uninfected people of the same age, says Dr Avron Urison of AllLife.

Three of these cancers are known as “acquired immunodeficiency syndrome (AIDS) defining cancers” or “AIDS-defining malignancies”: Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer. A diagnosis of any one of these cancers marks the point at which HIV infection has progressed to Aids.

People infected with HIV are several thousand times more likely than uninfected people to be diagnosed with Kaposi sarcoma, at least 70 times more likely to be diagnosed with non-Hodgkin lymphoma, and, among women, at least 5 times more likely to be diagnosed with cervical cancer.

In addition, people infected with HIV are at higher risk of several other types of cancer. These other malignancies include anal, liver, and lung cancer, and Hodgkin lymphoma.

Higher risk for anal cancer

People infected with HIV are at least 25 times more likely to be diagnosed with anal cancer than uninfected people, 5 times as likely to be diagnosed with liver cancer, 3 times as likely to be diagnosed with lung cancer, and at least 10 times more likely to be diagnosed with Hodgkin lymphoma.

People infected with HIV do not have increased risks of breast, colorectal, prostate, or many other common types of cancer. Screening for these cancers in HIV-infected people should follow current guidelines for the general population.

The connection between HIV/AIDS and certain cancers is not completely understood, but the link likely depends on a weakened immune system. Most types of cancer begin when normal cells change and grow uncontrollably, forming a mass called a tumor.

A tumor can be benign (non-cancerous) or malignant (cancerous, meaning it can spread to other parts of the body). The types of cancer most common for people with HIV/AIDS are described in more detail below.

Kaposi sarcoma

Kaposi sarcoma is a type of skin cancer that has traditionally occurred in older men of Mediterranean descent, young men in Africa, or people who have had organ transplantation. Kaposi sarcoma in people with HIV is often called epidemic Kaposi sarcoma. HIV/AIDS-related Kaposi sarcoma causes lesions to arise in more than one area of the body, including the skin, lymph nodes, and organs such as the liver, spleen, lungs, and digestive tract.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) is a cancer of the lymph system. Lymphoma begins when cells in the lymph system change and grow uncontrollably, which may form a tumor.

Cervical cancer

Cervical cancer starts in a woman's cervix, the lower, narrow part of the uterus. The uterus holds the growing fetus during pregnancy. The cervix connects the lower part of the uterus to the vagina and, with the vagina, forms the birth canal. Cervical cancer is also called cancer of the cervix.

Other types of cancer

Other, less common types of cancer that may develop in people with HIV/AIDS are Hodgkin lymphoma, angiosarcoma (a type of cancer that begins in the lining of the blood vessels), anal cancer, liver cancer, mouth cancer, throat cancer, lung cancer, testicular cancer, colorectal cancer, and types of skin cancer including basal cell carcinoma, squamous cell carcinoma, and melanoma.

Taking HAART (highly active antiretroviral therapy), as indicated based on current HIV treatment guidelines, lowers the risk of Kaposi sarcoma and non-Hodgkin lymphoma and increases overall survival. Although HAART has led to reductions in the incidence of Kaposi sarcoma and non-Hodgkin lymphoma among HIV-infected individuals, it has not reduced the incidence of cervical cancer, which has essentially remained unchanged.

Moreover, the incidence of several other cancers, particularly Hodgkin lymphoma and anal cancer, has been increasing among HIV-infected individuals since the introduction of HAART. The influence of HAART on the risk of these other cancer types is not well understood.

HIV positive and negative comparisons

The cancer prognosis for people infected with HIV tends to be worse compared to HIV negative cancer patients, regardless of the type of malignancy. Perhaps because of a suppressed immune system and impaired immune surveillance, malignancies take a more aggressive clinical course in those infected with HIV.

HIV positive patients typically present with more advanced cancer at the time of diagnosis, and the average age at diagnosis is usually younger in HIV positive patients compared to HIV negative patients.

This is particularly true with lung and testicular cancers. In addition, regardless of whether these cancers are directly related to HIV-induced immunosuppression, treating cancer in HIV positive patients remains a challenge because of drug interactions, compounded side effects, and the potential effect of chemotherapy on CD4 cell count and viral load.

Moreover, treatment compliance tends to be poor among HIV positive patients with cancer, perhaps because of the increased responsibility of taking drugs for both diseases. The question of whether to suspend HAART during chemotherapy depends on several factors, particularly the type and stage of malignancy and the status of HIV infection.

Therefore, individuals living with HIV should at their regular visits with their healthcare providers undergo correct screening for early detection of cancer and malignancy.

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