Living longer with HIV means that dying from cancer becomes more of a possibility.
The good news about HIV is that over the past several decades, antiretroviral therapy (ART) has made it possible for infected individuals to avoid developing full-blown AIDS and enjoy a much longer lifespan. The bad news is that they may be at higher risk of dying of cancer compared with uninfected individuals. While it’s true, naturally, that not dying of AIDS means they’ll die of something else, it’s also true that ongoing inflammation, even among patients who take ART, may hasten the development of cancer cells.
To find out just how many HIV patients are dying of cancer, and what kinds of cancer, a team from the National Cancer Institute in Rockville, Maryland examined data from a variety of studies on nearly 47,000 individuals with HIV, mostly male, who were receiving ART. The data spanned the years from 1995 to 2009, and participants were followed for an average of 5.7 years, for a total of more than 267,000 person years studied. The team separated AIDS-defining cancers such as Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer from non-AIDS-defining cancers such as lung, liver, colorectal, or prostate cancers.
The scientists found that 2.6% of deaths that occurred among the participants during the years of the study were due to AIDS-defining cancers, and 7.1% were due to non-AIDS-defining cancers, a total of almost 10% of deaths due to some type of cancer. The proportion of deaths due to non-AIDS-defining cancers grew during the study period. Older participants and men had a higher risk of death from cancer compared with younger participants and women. Participants whose CD4 blood counts were low, indicative of an immune system hampered by HIV, had the highest mortality rates from both AIDS-defining and non-AIDS-defining cancers.
“Immunosuppression increases the risk for some cancers, such as Kaposi sarcoma and non-Hodgkin lymphoma,” Eric Engels, MD, MPH, chief of the Infections and Immunoepidemiology and Genetics Branch of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, and the lead author of the study, told Contagion®. “Also, HIV-infected people with cancer have a higher risk of dying from their cancer than HIV-uninfected cancer patients, which might be due to immunosuppression or differences in cancer treatment.”
Lifestyle differences can come into play, too, according to Dr. Engels. “HIV-infected people in the United States frequently have infections with other viruses that cause cancer—for example, human papillomavirus [or] hepatitis C virus—and many HIV-infected people smoke cigarettes,” he said. “These factors contribute to the high risk of cancer.”
Health care providers who treat individuals with HIV can play a valuable role in helping them reduce their risk of cancer, either by helping them make lifestyle changes or being more proactive about disease treatments.
“Clinicians should focus on reducing cancer incidence by facilitating adherence to HIV treatment, enabling smoking cessation, and treating hepatitis B and C virus infections,” Dr. Engels told Contagion®. “In addition, HIV-infected cancer patients must be provided access to timely and effective cancer treatment, coordinated by experienced HIV and cancer specialists.”
Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.