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Screening advice
Feb 22, 2007

Greetings and MUCH gratitude to you Dr. Wohl. Your advice to others has been very helpful and informative to me.

I was diagnosed in 9/2005 - T-cells were (possibly) 28, VL was >100,000. Found a great Dr. who put me on Truvada/Reyataz/Norvir & the usual preventative antibiotics, etc.

I've had NO complications or side effects and went undetectable after 1 month. My labs last month were T-cells 530, still undetectable, all liver, kidney, misc. enzymes, hormones, lipids, etc all looking great.

I'm 43, enjoying great health, energy and life.

My question:

Should I have any special cancer screenings or do I need to do the usual colon, skin, etc. ones on the same schedule as an HIV neg. person? There's no history of cancer at all in my family on either side if that makes a difference.

Thank you in advance!

Response from Dr. Wohl

Great question. We know that people living with HIV infection are at greater risk of certain cancers such as lymphoma and Kaposi's sarcoma - particularly at lower CD4 cell counts. However, there is some evidence that other cancers may also be more prevalent in the setting of HIV. This may reflect another role of the immune system beside protecting the body from infection, namely, cancer surveillance. T-cells when detecting cancer cells register these cells as foreign and attack them. Therefore, reduced function of T-cells can impact cancer risk.

It is because of this that I urge that HIV+ people undergo the same routine cancer screenings recommended for those without HIV including breast, colon, and cervical cancer screenings. For men I also do screen for prostate cancer, especially among African-American men, those with a family history of prostate cancer and those on testosterone (or like) therapy. For these men I obtain a PSA annually after age 40. For other men I start screening a bit later.

I also am trying to get my patients who smoke to stop. This alone would reduce much of the cancers we will likely see. As melanoma of the skin is the best example of a cancer that we know the immune system responds to (melanoma vaccines are being developed) I urge my lighter skin patients to not spend much time in the sun without sunscreen. I can do little more than hang my head low when my tanning bed addicts come to clinic.

So, I would do the usual screening tests and err on the side of being more aggressive with these. As important as screening is prevention and we all must do what we can to reduce our risk of major cancers.

DW



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