There are several reasons to include information about cancer in this guide
- Some people are only diagnosed with HIV when their CD4 count is already very low or following a diagnosis of cancer. Very late diagnosis often includes an HIV-related cancer as part of the HIV diagnosis.
- The risk of most cancers increases with age. The longer we live–and luckily life expectancy has never been better–the greater the chance we will have to cope with cancer-related illnesses.
- Although rates of the three AIDS defining cancers (KS, NHL & cervical cancer) have fallen with access to HIV treatment, some non-AIDS defining malignancies (NADM) still occur at a higher rate in HIV positive compared to negative people.
- HIV positive people with side effects from cancer treatment may find some of the information in this guide useful.
HIV, treatment and cancer
Cancers that occur in HIV positive people were originally categorised as either AIDS defining on non-AIDS defining.
Combination HIV therapy has been able to reduce the risk of AIDS defining cancers but seems to have little effect on the risk of some non-AIDS defining cancers but not others. The risk of AIDS defining cancers increases at lower CD4 counts. This is one of the reasons behind the recommendation to start ARV treatment earlier.
To makes things complicated, some non-AIDS defining cancers occur at higher rates in people living with HIV and this may be unrelated to CD4 cell count or HAART use. Many of the NADM that occur more frequently in people living with HIV are linked to a virus. These include anal cancer in men and women (linked to HPV), Hodgkin’s lymphoma (linked to EBV) and liver cancer (linked to hepatitis B and C). A few cancers also occur more commonly in HIV positive people but are not linked to known viruses (lung cancer and melanoma).
Many cancers both NADM and ADM such as lymphomas have high chances of being cured and it is very important to seek treatment as soon as possible.
Other cancers don’t seem to be linked to either HIV or use of ARV treatment and are not more common in people living with HIV than in the general population. These tend to be cancers that are not linked to another virus, including breast, colon and prostate cancers. These cancers are increasing in HIV positive people using HIV treatment, because they are living longer for these age-related complications to occur.
For all cancers, early diagnosis and treatment is one of the most important factors for recovery.
This is a highly specialised aspect of medical care. If you are diagnosed with any cancer, whether formally HIV-related or not, you need to be treated by an expert in HIV-related cancer.
Table 8: Incidence of cancers affecting HIV-positive people and impact of ARVs
|Cancer (virus)||AIDS-defining||HIV risk vs HIV neg.||ARV impact||Comments|
|AIDS-defining cancers reduced by ARVs|
||Yes||Yes. Before ARVs rates were 70,000x (KS), 700x (NHL) and 3-8 times higher (cervical), respectively.||KS, NHL and CNS lymphoma are significantly reduced by ARVs. Rates of cervical cancer reduced in some studies.||KS generally only seen in people diagnosed late. ARVs are first-line KS treatment. Cervical cancer screening should start at a younger age and be more frequent in HIV positive women.|
|AIDS-defining cancers not reduced by ARVs|
||Yes||Higher.||ARVs improve outcome of cancer treatment but may not reduce the incidence.|
|Non-AIDS defining but higher risk in HIV positive people|
||No||Yes, but estimates vary by study. Approx 35x (anal), 10 x (HD), 2–5 times higher (lung, liver, head and neck, melanoma).||Incidence is not reduced by ARVs but HAART is essential to increase survival. Rates increasing due to living longer.||Screening for anal cancer in men and women is not currently routine, although recommended by some experts. Stopping smoking reduces lung cancer. All hepatitis coinfected people should be screened for liver cancer (6 monthly US and AFP). Avoid sunburn.|
|Not related to HIV or defined as AIDS related, not affected by HIV treatment|
||No||No||Rates are not reduced by ARV treatment. Rates are increasing due to living longer.||Screening recommended as part of general population screening|
KS: Kaposi’s Sarcinoma; HD: Hogdkins Disease; NHL: Non-Hodgkins Lymphoma; EBV: Epstein Barr Virus; HHV-8: Human Herpes Virus-8; HPV: Human Papilloma Virus; CNS: Central Nervous System.
NOTE: This table only refers to broad cancers in general terms. HIV-related cancers that occur at very low rates are not included.
1 July 2012