The connection between HIV and cancer
Advances in treatment have greatly improved the outlook for people living with HIV. Regular antiretroviral therapy has made it possible for people living with HIV to live long, full lives. And regular antiretroviral therapy makes it virtually impossible for a person with a persistent undetectable viral load to transmit HIV to others.
However, the effects HIV has on a person’s immune system can increase their risk for other conditions, including cancer. This is because the virus makes it harder for the body to fight other infections and diseases. For people living with HIV, this means it can increase their risk for cancer.
Some types of cancer are more common in people with HIV than in people without it. There are also types of cancers known as “AIDS-defining cancers”. These signal the transition from HIV to stage 3 HIV, also known as AIDS.
However, there are ways to reduce the risk of developing cancer, as well as treatment options. Read on to learn about HIV and cancer, risk factors, treatment, and more.
From 1996 to 2009, the North American AIDS Cohort Collaboration on Research and Design studied about 280,000 people to examine HIV and cancer trends. The study looked at more than 86,000 people living with HIV and nearly 200,000 people 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 that HIV-associated deaths are decreasing by 9 percent per year. This can also increase the risk for developing cancers. “The effectiveness of ART [antiretroviral therapy] has enabled persons with HIV to live long enough to have cancer,” the researchers noted.
According to the National Cancer Institute (NCI), people living with HIV are 500 times more likely to develop Kaposi sarcoma (KS). This is a type of blood vessel 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 people with an uncompromised immune system.
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. It can be fatal, but is curable with treatment.
KS can be a sign that HIV has developed into stage 3 HIV. However, antiretroviral therapy has reduced the incidence of KS. Taking medication as directed can lower the risk for KS and increase life expectancy. KS tends to shrink with a strong immune system. Learn more about the different types of Kaposi sarcoma.
Like KS, non-Hodgkin’s lymphoma (NHL) is another condition that signals the transition to stage 3 HIV. However, the risk of developing it can be decreased with the use of antiretroviral therapy. NHL is the second most common cancer associated with stage 3 HIV. The NCI estimates people living with HIV are 12 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 8 percent of these cases affect the brain and spinal fluid, according to a 2005 review. The Epstein-Barr virus (EBV) causes some subtypes of NHL.
Symptoms of NHL can include:
- facial paralysis
Treatment involves chemotherapy. A person’s outlook depends on a variety of factors, including blood cell count, stage of disease, and immune system function. Learn more about non-Hodgkin’s lymphoma, including types and other risk factors.
According to the NCI, women living with HIV are 3 times more likely to develop cervical cancer than other women. Cervical cancer has a strong link to the human papillomavirus (HPV), a sexually transmitted disease. Women with uncompromised immune systems have a better outlook. But it also depends on the stage of the cancer and a woman’s CD4 count, and treatment is available.
Women living with HIV are at higher risk of cervical intraepithelial neoplasia (CIN). This is 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, but a healthcare provider can work toward finding the most effective treatment.
Contracting HPV is a major risk factor for people living with HIV. This virus can cause cervical cancer and other cancers. These include:
- anal cancer
- mouth cancer
- penile cancer
- vaginal cancer
- head and neck cancer
- throat cancer
The NCI estimates anal cancer is 19 times more likely to develop in people living with HIV. The risk can also increase for men living with HIV who have sex with men, notes NAM. For people who are at risk of anal cancer, a healthcare provider can recommend testing and standards of care, such as anal Pap tests and treating early lesions.
The hepatitis B and C viruses can lead to liver cancer. The NCI estimates people living with HIV are 3 times more likely to receive a liver cancer diagnosis. Heavy alcohol use can also increase this risk.
Treatment for hepatitis B and C can differ when someone has HIV. A healthcare provider can work out a treatment plan tailored to a person’s specific needs. Learn more about HIV and hepatitis C coinfection.
Other less common cancers that may develop include:
There’s been an increased incidence of colorectal cancer in people with HIV and stage 3 HIV. Researchers are still conducting studies because the link between the two conditions isn’t clear.
According to a study of 298 people living with HIV, there was no difference in the prevalence of polyps between people living with HIV and people who weren’t. But the study’s researchers found that those with HIV and stage 3 HIV were at greater risk for advanced neoplasms. These are areas of cancerous cell growth that don’t 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. Misusing alcohol can result in cellular changes that increase the risk for developing certain cancers. These include liver cancers.
- Sharing needles. Sharing needles 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.
Antiretroviral therapy reduces the amount of HIV that circulates within the blood, boosting the ability of the immune system to fight the virus. 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 better outlook for people with some types of cancer:
- Liver cancer. Getting tested for hepatitis can provide an early diagnosis. If a person believes they’ve contracted hepatitis, they should seek immediate treatment and ask their healthcare provider if they 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 the risk of developing lung cancer.
Learn more about early detection for HIV-related cancers by talking with a healthcare provider.
Treating cancer alongside HIV depends on:
- the type of cancer
- stage of cancer
- a person’s overall health
- immune system function, such as CD4 count and viral load
- reaction to treatment or medication
Generally, people living with HIV or stage 3 HIV go through the same cancer treatment people without HIV go through. Standard treatments for cancer include:
There are many factors to consider when it comes to one’s outlook. A compromised immune system may affect the success rates of different treatments. A healthcare provider can work with a person living with HIV to tweak treatment as necessary.
For cancers that spread to another part of the body, there are clinical trials. One may also want to get a second opinion before starting treatment.