HIV and Cancer
WHat's the link between hiv and cancer?
Even when a person with HIV takes cART as prescribed and has an undetectable viral load, they are more likely to develop cancer than the general population.
AIDS DEFINING CANCERS
Kaposi Sarcoma, Non-Hodgkin Lymphoma, Cervical Cancer
AIDS-defining cancers are cancers that were seen at high rates in people with HIV at the beginning of the AIDS pandemic. If a person is diagnosed with one of these cancers, they are said to have AIDS. With the widespread use of cART, the incidence of these cancers in people with HIV has dropped.
NON-AIDS DEFINING CANCERS
Anal Cancer, Hodgkin Lymphoma, Lung Cancer, & others
Non-AIDS defining cancers are cancers that are now seen at higher rates in people with HIV due to aging as a result of increased life expectancy, co-infection with cancer-causing viruses like HPV and EBV, lifestyle risk factors like smoking, and immunosuppression.
HIV and CanceR
Why are people living with HIV (PLWH) at higher risk for cancer?
Cancer doesn’t discriminate against HIV or AIDS. In fact, people living with PLWH are at higher risk of developing cancer than the general population. But why? HIV is a virus that works by attacking the body’s immune system. It infects a type of white blood cell called a CD4+ T cell that plays an important role in the immune system. CD4+ T cells help your body fight infections and cancer. When HIV infects CD4+ T cells, it makes copies of itself inside the cell before destroying it. If untreated, HIV continues this vicious cycle until nearly all CD4+ T cells are destroyed. When CD4+ T cell counts are low, the body is at increased risk for infection and cancer, like Kaposi’s sarcoma (KS), non-Hodgkin lymphoma (NHL), and cervical cancer.
AIDS is diagnosed in PLWH when the CD4+ T cell count drops below 200 cells/m3, which is considered a dangerously low level that results in such impairment of the immune system that the body is unable to protect itself. Because KS, NHL, and cervical cancer commonly occur in PLWH who likely have low CD4+ T cell counts, they are called AIDS-defining cancers (ADCs). If PLWH are diagnosed with an ADC, they are also diagnosed with AIDS regardless of CD4+ T cell counts. In fact, doctors first recognized the HIV/AIDS epidemic due to an increase in rare infections and cancers like KS that only occur in people with severely impaired immune systems. ADCs occurred at extremely high rates in PLWH in the 80s, 90s, and early 2000s. However, when highly active antiretroviral therapy (HAART) became the standard for HIV treatment, the rates of ADCs significantly dropped. Long-term use of HAART results in undetectable HIV viral loads and normal CD4+ T cell counts, allowing the immune system to function normally. While the rates of ADCs have dropped, there has been a steady increase in the rates of other types of cancer not previously associated with HIV. These cancers are collectively referred to as non-AIDS defining cancers (NADCs), and include Hodgkin lymphoma and cancers of the mouth, throat, liver, lung, and anus.
PLWH, even those on long-term HAART with undetectable viral loads and normal CD4+ T cell counts, are at higher risk for NADCs than the general population. This is due to a variety of factors including chronic immune activation from HIV, high rates of cancer-causing viruses in PLWH, and lifestyle behaviors like tobacco and alcohol use. In addition, PLWH on long-term HAART have life expectancies similar to the general population. Age is a major contributing factor in the development of cancer, so the increasing age of the HIV population naturally contributes to higher rates of cancer.
Cancer Treatment and Outcomes in PLWH
PLWH are not only at increased risk for cancer, they are also more likely to go untreated and die from cancer. This is in part due to misinformation and lack of provider education on cancer in PLWH. At the beginning of the HIV pandemic when there was no available treatment, the virus was a death sentence. Treating cancer in people with uncontrolled HIV was extremely difficult due to their immune compromised state, and the cancer would ultimately prove fatal. Today, however, thanks to HAART, HIV is a manageable illness. Cancer can be effectively treated in PLWH. Guidelines for cancer treatment are largely the same between PLWH and the general population and include standard cancer treatments like chemotherapy, immune therapy, radiation therapy, and surgery. The most notable difference in cancer treatment in PLWH is the need for concomitant HIV management by an HIV specialist. The National Comprehensive Cancer Network (NCCN), which publishes treatment guidelines for doctors caring for cancer patients, has published specific treatment guidelines for cancer in PLWH. It is important that providers stay up to date on cancer treatment in PLWH. It is also important that PLWH undergo appropriate cancer screening to detect cancer at an earlier stage. Ask your doctor about your risk for cancer and what cancer screenings you are eligible for, like Pap smears, mammograms, and colonoscopies. If you are a person living with HIV who has been diagnosed with cancer, ask your doctor about treatment options, NCCN guidelines, and clinical trials you may be eligible for.
people with hiv have poorer cancer outcomes
Comparison of cancer treatment between HIV+ and HIV- patients. Treatment rates between HIV+ and HIV- were significantly different in all cancer types except anal cancer. Data from Suneja G, Lin CC, Simard EP, Han X, Engels EA, Jemal A. Disparities in cancer treatment among patients infected with the human immunodeficiency virus. Cancer. 2016 Aug 1;122(15):2399-407. doi: 10.1002/cncr.30052. Epub 2016 May 17. PMID: 27187086.
HIGHER MORTALITY Rates
Mortality rate per 1000 person years from patients in 6 U.S. states by gender. Reference group included patients without HIV and cancer. Data from Coghill, A. E., Pfeiffer, R. M., Shiels, M. S., & Engels, E. A. (2017). Excess Mortality among HIV-Infected Individuals with Cancer in the United States. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 26(7), 1027–1033. https://doi.org/10.1158/1055-9965.EPI-16-0964
We know the terminology used when discussing cancer and HIV is confusing.
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All data and information provided on www.cancerfreehiv.org comes from peer-reviewed sources. Publications from which data are obtained are listed at the bottom of figures or each page