September 15, 2015
Table of Contents
Cancer refers to the abnormal and uncontrolled growth of certain cells that can get in the way of normal body functions. Cancer can spread (metastasize) from where it starts growing to other organs and parts of the body. Cancer can destroy healthy cells and cause illness and death.
A healthy immune system helps to prevent cancer. Because those living with HIV (HIV+) have weakened immune systems, it is easier for people living with HIV to become ill with several kinds of cancer. People living with HIV are more likely to be infected with viruses that can lead to cancer. These viruses include:
The following types of cancer lead to an AIDS diagnosis: Kaposi's sarcoma, certain types of lymphoma, and cervical cancer. Other non-AIDS defining cancers for which people living with HIV are at increased risk include anal, liver, and lung cancer. All of these are explained in detail below.
KS was one of the most common opportunistic infections (OIs) in the early days of the AIDS epidemic.
HHV-8 is the virus that causes KS. It is transmitted through sexual contact or blood products. KS has always been less common in women than in men, but is less common in all people with HIV since the use of newer, more effective HIV drug combinations.
A recent study found that some people living with HIV who have KS find that their KS gets worse after starting HIV drugs. This is most likely due to IRIS (immune reconstitution inflammation syndrome), which happens when your immune system acts so strongly and so quickly that it causes lots of inflammation that can actually make your symptoms worse. KS-IRIS usually happens more often in people living with HIV who have higher HIV viral loads, higher KS viral loads, and more advanced KS disease.
KS on the skin is not life threatening. However, if KS spreads to other parts of the body, especially the lungs, it can cause serious problems. An oncologist (a doctor who specializes in cancer) usually suggests treatment options based on factors such as the size, number, and location of KS tumors. However, the first treatment for KS is to begin HIV drugs. Your HIV provider and other specialists (e.g., radiation oncologist, dermatologist) may be involved as well.
Lymphoma involves the uncontrolled growth of lymph cells that may spread to other organs, including bone marrow, the brain or spinal cord (central nervous system, or CNS lymphoma), and the gastrointestinal tract (GI lymphoma). The Epstein-Barr virus (EBV) may play a role in the development of lymphomas.
The two major types are:
Lymphomas can be more advanced and harder to treat in people living with HIV, especially CNS lymphoma.
Cervical cancer is strongly linked to the human papilloma virus (HPV). HPV is the most common sexually transmitted infection in the US. Different strains of HPV cause warts or abnormal cell growth (dysplasia) near the anus or cervix (entrance to the womb).
Dysplasia is more common in women with advanced HIV disease and low CD4 cell counts. It is often more severe and difficult to treat than in HIV-negative women. Untreated dysplasia can lead to cervical cancer, which can be life threatening. HPV may also cause cancer in the vagina, vulva, and anus.
The good news is, when dysplasia is found and treated early, cervical cancer can be prevented. Cervical screening tests are used to look for changes in the cervix, including dysplasia and cervical cancer. Cervical cancer usually takes years to develop, and it does not usually have symptoms until it is quite advanced. This is why getting screened for cervical cancer on a regular basis is important; screening can catch potential problems before they get worse. For more information on getting a gynecologic exam, see our article on Caring for a Woman's Body.
The other good news is that there are three widely used HPV vaccines: Gardasil (made by Merck; also known as Silgard), Gardasil-9 (also made by Merck), and Cervarix (made by GlaxoSmithKline). These vaccines protect against the types of HPV that cause the most cervical cancers and genital warts. Pregnant women should not receive the vaccine, although it is safe to get the vaccine while breastfeeding.
All three vaccines have been approved by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA). Gardasil-9 is still awaiting approval in the UK and Canada. In the US, Gardasil is approved for females and males ages 9 to 26, while Cervarix is approved for females ages 10 to 25. The same is true in Canada.
It is best if young people get all doses of the vaccine before their first sexual contact. This helps them develop an immune response before they are exposed to HPV. People who are infected with some types of HPV may still benefit from the vaccine's effects against other types of HPV. The US Centers for Disease Control and Prevention (CDC) recommends HPV vaccines for all girls and young women ages 11 through 26 and all boys and young men ages 11 through 21 (even if they have already become sexually active).
In Canada, the National Advisory Committee on Immunization (NACI) recommends Gardasil vaccination for females and males ages nine through 26, or vaccination with Cervarix for girls and young women ages nine through 26. In the UK, vaccination with Gardasil is offered to girls ages 12 and 13 through the National Health Service.
Screening for dysplasia and cervical cancer is essential to find and treat early pre-cancerous changes and to prevent cervical cancer. Traditionally, the Papanicolaou test (Pap test or Pap smear) has been done. This test uses a small brush to collect a few cells to check for changes in the cervix. Now, liquid based systems to screen samples of cervical cells are much more common and are effective for finding abnormal cells.
Treatment depends on the type of cervical cancer and how far it has spread. Often, more than one kind of treatment is used.
Anal cancer is on the rise, in men as well as women. It is also tied to specific strains of HPV. An anal Pap smear and physical examination are the best ways to detect anal dysplasia. It is important to ask your health care provider to perform these tests on a regular basis. Because some of the same strains of HPV that cause cervical cancer can cause anal cancer, getting vaccinated with one of the two FDA-approved HPV vaccines can help to prevent anal cancer, too.
The increased risk for liver cancer among people living with HIV is strongly linked to infection with the hepatitis B and/or hepatitis C viruses (HBV and HCV, respectively). Researchers have also shown a direct link between having a low CD4 cell count and having an increased risk for liver cancer. Other factors involved in damaging the liver include opportunistic infections (e.g., Mycobacterium avium complex, tuberculosis, cytomegalovirus, and cryptosporidium), excessive alcohol and recreational drug use, and even some HIV drugs.
Depending on the size, type, and location of the liver cancer, your provider will suggest treatment, which may include:
Although lung cancer is not an AIDS-defining cancer, people living with HIV have a greater chance of developing lung cancer than HIV-negative people. This difference is likely due to the weakened immune systems of those living with HIV. Unfortunately, lung cancer is one of the deadliest cancers. In the US, it is the leading cause of cancer-related deaths among both women and men.
An increased risk of developing lung cancer is also strongly tied to smoking. Both the duration (how long) and amount (how much or how many per day) of smoking contribute to the risk for lung cancer. Second-hand smoke exposure (breathing smoke in the environment) also contributes to an increased risk for lung cancer.
Researchers recently reported that smoking is the single biggest risk factor for non-AIDS defining cancers among people living with HIV in the US. Smoking has more of an effect on the risk of a person with HIV getting cancer than having a low CD4 count, a non-suppressed viral load, hepatitis C, or an AIDS diagnosis.
The best way to prevent lung cancer is to avoid or stop smoking. For more information, see our article on Smoking and Tobacco Use.
Depending on the size, type, and location of the lung cancer, cancer specialists will recommend some combination of chemotherapy, radiation therapy, and surgery.
Cancers can be very serious for people living with HIV. On-going medical care allows for early diagnosis and treatment, or even prevention, in the case of cervical and anal cancers.
Seeing your health care provider on a regular basis and taking your HIV drugs regularly can help keep your immune system strong and your CD4 cell counts up. This also helps fight off cancers.