What Is a "Malignancy"?The word “malignancy” means a cancer. Specifically, cancer is an abnormal growth of cells that divide uncontrollably and may spread to other parts of the body. There are many kinds of cancer, which can involve just about any part of the body.
How Does This Relate to HIV Disease or AIDS?
Early in the AIDS epidemic, doctors saw patients suffering from a rare cancer called Kaposi’s sarcoma (KS). This cancer caused dark purple patches on the skin and even inside the mouth and lungs. Eventually, KS was identified as one of several opportunistic infections (OIs) that people with AIDS are susceptible to because of their weakened immune systems. OIs are caused by microorganisms like bacteria, funguses, and viruses, which are usually kept under control by a healthy immune system. However, in someone with AIDS, they can produce major infections and cause death. All AIDS-related cancers are caused by viruses that are usually harmless in people with healthy immune systems. The bottom line is that people with HIV/AIDS are at greater risk for certain cancers than people with healthy immune systems. These cancers are sometimes called “AIDS malignancies.”
What Kinds of Cancers Are AIDS Malignancies?
Three major AIDS malignancies are KS, cervical cancer, and non-Hodgkin's lymphoma (NHL). As people with HIV/AIDS live longer because of anti-HIV therapy, the number of cases of some cancers (like KS and primary brain lymphoma) has gone down. This could be because such cancers usually occur at low T cell counts and anti-HIV medications generally raise T cell counts. However, several studies show that the number of cases of other cancers, like NHL, is holding steady or even increasing. Such cancers typically can occur at higher T cell counts, so anti-HIV medications may not help. In fact, more cases of such cancers may be seen as people on anti-HIV medications live longer. Another consideration is that people with HIV/AIDS seem to be at greater risk for certain “non-AIDS-related cancers” like Hodgkin’s disease, lip cancer, testicular cancer, anal/rectal cancer, lung cancer, and skin cancer. Some researchers even have suggested that the list of AIDS malignancies may be expanded to include cancers like Hodgkin’s disease, where a suppressed immune system is a risk factor.
What Kinds of Viruses Can Cause AIDS Malignancies?
KS is associated with human herpesvirus 8 (HHV-8). This virus is sometimes called “Kaposi’s sarcoma-associated herpesvirus.” The virus is likely transmitted through saliva. Fortunately, the number of cases of KS has decreased dramatically since the introduction of potent anti-HIV therapy.
Cervical cancer is caused by certain types of the human papillomavirus (HPV). This virus also can cause genital and oral warts. It is spread by contact with infected areas of the body. Some forms of this virus are low-risk for cancer (like HPV-6 and HPV-11) while other forms are high-risk for cancer (HPV-16 and HPV-18). Women should get regular Pap tests to detect any cell abnormalities (“dysplasia”) that may be caused by this virus and may indicate the beginnings of cancer. This same virus causes anal cancer. Some HIV-treating physicians are using the Pap test to screen for anal cancer in men and women. Successful anti-HIV therapy helps reduce, but does not eliminate, the risk of cervical cancer in women.
AIDS-related NHL is associated with the Epstein-Barr Virus (EBV), a type of herpes virus that infects almost all humans by young adulthood. Lymphoma involves immune cells called “B lymphocytes.” Since these cells are almost everywhere in the body, tumors can arise in a number of locations (bone, brain, abdomen, lungs, etc.) and spread through the body’s lymphatic system.
What Can Be Done to Prevent AIDS Malignancies?
The first thing to remember is that all people are at some risk for cancer. One helpful intervention is going to your doctor regularly for check-ups, blood work, and preventive cancer screening (like a Pap test). Also, be aware of any unusual bumps or lesions (sores) on your body that do not seem to go away. Report anything suspicious to your doctor. Women can self-inspect their breasts and men can self-inspect their testicles to feel for cancerous or precancerous lumps. In addition, do not ignore symptoms such as unexplained fever or weight loss. Also, lifestyle factors may affect the risk of developing certain cancers (just as in the general population). A balanced diet (rich in essential vitamins and nutrients) and regular exercise can help keep your immune system healthier and might even lower the risk of some cancers. Limiting alcohol, recreational drug, or tobacco use may have a positive effect on the immune system as well.
How Can AIDS Malignancies Be Treated?
Many cancers are treated with chemotherapy or radiation treatment, depending on the specific kind of cancer. Chemotherapy may be injected or even taken orally. Some treatments are very specific for the kind of cancer they treat, so the various drugs used to treat cancer are too many to list. However, one important finding has been that highly active anti-HIV therapy (sometimes called “HAART”) can improve a patient’s response to chemotherapy and increase the overall survival time of patients with AIDS-related lymphoma. Regardless of the type of cancer involved, it’s important to see a cancer specialist, especially one experienced in treating that cancer and possibly experienced in treating AIDS malignancies.
Where Can I Call for More Information, or for a Referral to a Physician Who Specializes in HIV?
You can call The Center for AIDS at 713.527.8219 or toll free at 888.341.1788.