HIV is the virus that can lead to AIDS. While there is no cure, advances in treatment have improved the outlook for people with HIV. But the effects HIV has on a person’s immune system can increase the risk for other conditions, including cancer.
The virus makes it harder for the body to fight other infections and diseases. For people with HIV this means it can increase their risk for cancer. Some types of cancer are more common in people with HIV than in the general population. There are also types of cancers, known as AIDS-defining cancers, that signal the transition from HIV to AIDS.
From 1996 to 2009, the North American AIDS Cohort Collaboration on Research and Design studied about 280,000 people to look at HIV and cancer trends. The study looked at more than 86,000 people with HIV and nearly 200,000 adults without HIV.
According to the study published in the Annals of Internal Medicine, the incidence of the following cancers are as follows:
|Cancer||Incidence in people with HIV||Incidence in people without HIV|
|Kaposi sarcoma||4.4 %||0.1 %|
|non-Hodgkin's lymphoma||4.5 %||0.7 %|
|lung cancer||3.4 %||2.8 %|
|anal cancer||1.5 %||0.05 %|
|colorectal cancer||1.0 %||1.5 %|
|liver cancer||1.1 %||0.4 %|
The study also found the mortality rate associated with HIV is decreasing by 9 percent per year. Living longer with HIV can also increase the risk for developing cancers. The researchers noted, “The effectiveness of ART [antiretroviral therapy] has enabled persons with HIV to live long enough to have cancer.”
According to the National Cancer Institute, people with HIV are several thousand times more likely to develop Kaposi sarcoma (KS), a type of skin cancer. KS is linked to a virus called human herpesvirus 8 (HHV-8). This virus spreads through sexual contact and saliva. It doesn’t usually cause cancer in healthy people.
Early symptoms aren’t always obvious. Some people develop dark skin or mouth lesions. Other symptoms include weight loss and fever. KS can affect the lymph nodes, digestive tract, and major organs, and can be fatal.
KS is also known as an “AIDS-defining condition” because it can be sign that HIV has developed into AIDS. Highly active antiretroviral therapy (HAART) has reduced the incidence of KS. Taking medication as directed can lower the risk for Kaposi sarcoma and increase life expectancy. KS tends to shrink with a strong immune system.
Like KS, non-Hodgkin's lymphoma (NHL) is another AIDS-defining condition. The risk of developing it can be decreased with the use of HIV medications. NHL is the second most common cancer associated with AIDS. It affects about 4 to 10 percent of people with HIV or AIDS. People with HIV are 70 times more likely to develop NHL.
There are many types of NHL. NHL begins in lymphoid tissue and spreads to other organs. Primary central nervous system lymphoma starts in the spinal cord or brain. About 20 percent of these cases affect the brain and spinal fluid. The Epstein-Barr virus (EBV) causes some subtypes of NHL.
Symptoms of NHL include confusion, fatigue, facial paralysis, and seizures. Treatment involves chemotherapy, but the outlook depends on a variety of factors, including blood cell count, stage of disease, and immune system function.
According to the National Cancer Institute, women with HIV are five times more likely to get cervical cancer than other women. Cervical cancer has a strong link to the human papillomavirus (HPV), a sexually transmitted virus. The outlook for invasive cervical cancer and HIV is better for women with healthy immune systems. But it also depends on the stage of the cancer and the CD4 count.
Women with HIV are at higher risk of cervical intraepithelial neoplasia (CIN), a growth of precancerous cells in the cervix. There are usually no symptoms, but CIN can progress to cervical cancer. CIN is harder to treat in women with HIV.
One study shows that Pap test abnormalities are common. It’s important to get screened regularly for cervical cancer.
HPV infection is a major risk factor for people with HIV. This virus can cause cervical cancer and other cancers that include:
- anal cancer
- mouth cancer
- penile cancer
- vaginal cancer
- head and neck cancer
- throat cancer
Anal cancer is 25 times more likely to develop in people with HIV. The risk can increase up to 40 times more for men with HIV who have sex with men. Talk to your doctor if you’re at risk for anal cancer. They’ll be able to recommend testing and standards of care such as anal Pap tests and treating early lesions.
People with HIV are three times more likely to develop lung cancer. This risk increases for people who smoke.
The hepatitis B and C viruses can cause liver cancer. People with HIV are five times more likely to get a liver cancer diagnosis. Alcohol abuse and dependence also increase this risk. Treatment for hepatitis B and C can differ when someone has HIV. Talk to your doctor if you’ve been infected with either virus.
Other less common cancers that may develop include:
- Hodgkin's lymphoma
- angiosarcoma, a cancer that affects the blood vessels
- testicular cancer
- skin cancer
There’s been an increased incidence of colorectal cancer in people with HIV and AIDS. Researchers are still conducting studies because the link between the two conditions isn’t clear.
According a study of 298 people who have HIV, there was no difference in the prevalence of polyps between people who have the infection and people who did not. But, the study’s researchers found those with HIV and AIDS were at greater risk for advanced neoplasms, or areas of cancerous cell growth that do not resemble polyps.
A compromised immune system can increase a person’s risk for cancer. It can also allow for cancer cells to spread faster than in someone without HIV. But lifestyle factors also affect one’s risk.
Examples of risk factors include:
- heavy alcohol use: Alcohol abuse can cause cellular changes that increase the risk for developing certain cancers. These include liver cancers.
- IV drug use: Sharing needles for drugs like heroin and methamphetamine can increase the likelihood of contracting hepatitis B or C. Hepatitis B or C can impair liver function and increase the risk for liver cancer.
- smoking: Smoking is known to contribute to lung cancer.
HAART (sometimes called ART) reduces the amount of HIV that circulates within the blood, boosting the ability of the immune system to fight infection. While incidence of KS and NHL is decreasing, the risk for developing these cancers is still higher for people with HIV.
Early detection and treatment can result in a more positive outlook for some types of cancer:
- liver cancer: Get tested for hepatitis. If you know you’ve been infected, seek immediate treatment and ask your doctor if you should give up alcohol.
- cervical cancer: Regular Pap tests can detect early abnormalities that can lead to cervical cancer.
- anal cancer: An anal Pap test can detect anal cancer in its earliest stages.
- lung cancer: Don’t smoke. This lifestyle change can significantly lower your risk of developing lung cancer.
Talk to your doctor to learn more about early detection for HIV-related cancers.
Treating cancer alongside HIV and AIDS depends on:
- the type of cancer
- stage of cancer
- your overall health
- immune system function, such as CD4 count and viral load
- reaction to treatment or medication
Generally, people with HIV or AIDS go through the same cancer treatment people without HIV go through. Standard treatments for cancer include:
- targeted therapy
There are many factors to consider when it comes to your outlook. A compromised immune system may affect the success rates of different treatments. For cancers that spread to another part of your body, there are clinical trials. You may also want to get a second opinion before starting treatment.