Sunday, November 6, 2011

Does HIV Infection and AIDS Result in an Increased Risk of Cancer?

The answer to this question is Yes. The people with HIV (Human Immunodeficiency Virus) infection have been seen to develop more cancers compared to those uninfected. In fact, according to NCI (National Cancer Institute), people infected with HIV have a substantially higher risk of developing some types of cancer compared to uninfected people of same age. The three AIDS defining cancers (Diagnosis of any of these 3 cancers marks the point at which HIV infection has progressed to AIDS) include  Kaposi sarcoma, Non-Hodgkin's Lymphoma and Cervical cancer.

Compared to uninfected individuals, HIV positive individuals are:
  • several thousand times more likely to be diagnosed with Kaposi sarcoma,
  • at least 70 times more likely to be diagnosed with Non-Hodgkin's Lymphoma,
  • and among women, at least 5 times more likely to be diagnosed with Cervical cancer.
HIV infected people are also at increased risk of the following cancers in comparison to the uninfected people:
  • Anal cancer (25 times more likely to be diagnosed),
  • Liver cancer (5 times more likely to be diagnosed),
  • Lung cancer (3 times more likely to be diagnosed),
  • Hodgkin Lymphoma (at least 10 times more likely to be diagnosed)

HIV infected individuals do NOT have an increased risk of the following cancers: (Screening for the following cancers should follow the same guidelines as the ones for general population)
  • Breast cancer,
  • Colorectal cancer,
  • Prostate cancer,
  • and many other common cancers.

The reason for this increased risk is due to the weakened immune system that leads to reduced ability of the HIV infected person's body to fight infections that may lead to cancer.

  • HHV-8 (Human Herpes Virus type 8) also known as KSAH (Kaposi Sarcoma Associated Herpesvirus) is the causative agent for Kaposi Sarcoma.
  • EBV (Epstein Barr Virus) causes Non-Hodgkin's Lymphoma and Hodgkin's Lymphoma.
  • HPV (Human Papilloma Virus) causes cervical cancer, anal, penile, vulvar, vaginal, and head and neck cancers.
  • HBV (Hepatitis B Virus) and HCV (Hepatitis C Virus) are both known causes for liver cancer.

Another reason is that many HIV positive persons are also infected with these other viruses (mentioned above) that may cause cancer.

Lastly, HIV positive individuals are more prone to harbor some of the traditional risk factors of cancer like smoking (associated with lung, oral, laryngeal, esophageal, stomach, pancreatic, colorectal, kidney, bladder, and other urinary cancers, cervical cancer, and poorer AML outcomes) and heavy alcohol use (liver cancer, breast cancer, oral, pharyngeal, laryngeal, esophageal cancer).

HAART (Highly Active Anti-Retroviral Therapy) has been able to decrease the incidence of Kaposi sarcoma and NHL in HIV positive individuals. Cervical cancer incidence has not reduced. The incidence of Anal cancer and Hodgkin Lymphoma is on the rise since the induction of HAART. The use of HAART in the treatment of HIV positive individuals has led to more of these patients living past their 40s and they are increasingly being diagnosed with the other non AIDS related cancers but not at earlier ages than the general population as discussed earlier.

Taking HAART as prescribed, quitting smoking and alcohol, managing Hepatitis B and C, screening for Cervical and Anal cancer with a PAP test are some recommendations to prevent, screen for and manage the above discussed cancers in HIV positive and AIDS patients.

Further reading and References:

Link1 (NCI at NIH)
Link2 (CDC study)

Thank you for updating your medical knowledge at Online Health Expert.
Dr. Harish Malik

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Dr. Harish Malik

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