Prevention of HIV Associated Cancer

Executive Summary

The prevention from HIV associated cancer include beneficial effects of cART on HIV replication, inflammation, and immune function. The screening of HPV associated malignancies is carried out to reduce the risk of HIV associated cancer. The various screening of HPV associated malignancies inlcude cervical cancer screening, and anal cancer screening. The other preventive measures include HPV vaccine, Hepatocellular Carcinoma (HCC) Prevention and early detection, and smoking cessation interventions.

Prevention of HIV or AIDS Related Cancer

The beneficial effects of cART on HIV replication, inflammation as well as immune function suggest that cART use reduces the overall risk of HIV associated cancer.

Antiretroviral therapy

The beneficial effects of cART on HIV replication, inflammation as well as immune function suggest that cART use reduces the overall risk of HIV associated cancer.

The widespread introduction of cART for HIV treatment in 1996 reduced the incidence and mortality of patients suffering from AIDS-related PCNSL (Primary central nervous system lymphomas), KS, and systemic NHL. In the United States, cART has helped to reduce the incidence of KS by 84% and of non-Hodgkin’s lymphoma by 57%^​1​.

Screening for HPV-associated malignancies

Cervical Cancer Screening

In the United States, the cervical cancer incidence in the general population is 8 per 100,000 women per year and 26 per 100,000 among HIV-infected women per year. In India, more than 100,000 women are diagnosed with cervical cancer, and more than 60,000 women die every year from the disease^​2​. Women infected with HIV are more likely to have precancerous lesions, including high-grade squamous intraepithelial damage (HSIL), low-grade squamous cell intraepithelial damage (LSIL), and cancer. In addition, HIV-infected women have a higher rate of recurrence of HSIL in the cervix after treatment. In situations where Pap (Papanicolaou) testing programs are not available, a “screen and treat” approach may be evaluated to reduce the incidence of cervical cancer. These strategies use VIA (visual examination with acetic acid) or HPV tests to assess the presence of cancer. If a VIA-positive or oncogenic HPV is confirmed, cryotherapy can be performed immediately, allowing screening and treatment of patients all at once without colposcopy, biopsy, or cytopathology.

Anal Cancer Screening

HIV-infected men (MSMs) who have sex with men have a significantly higher risk of anal cancer than the general population. HIV-infected women also have a higher incidence of anal HPV infection than HIV-negative women. Risk factors for development associated with rectal HSIL and anal cancer include high-risk HPV infection (usually serotype 16) and low CD4+ levels. Based on the cervical cancer screening model, routine cytological examination of the anal mucosa and evaluation of the healing of pre-cancerous lesions in HIV-infected patients has the potential to reduce the incidence of anal cancer. Anal Pap followed up with high-resolution anoscopy are generally used for anal cancer screening^​3​.

HPV Vaccine

Antibodies to HPV can be neutralized by immunization with HPV-like particles containing the L1 virus protein. The vaccine provides almost 100% protection against HPV 16 and 18 infections among non-HIV infected patients and is effective in preventing anogenital diseases, including cervical HSIL. The HPV4 vaccine has been shown to be effective in reducing anal intraepithelial neoplasia (AINs) by 54.2% among HIV-uninfected MSM individuals (aged 16–26 years), confirming the potential role of this approach in reducing the risk of anal canal cancer^​1​.

Hepatocellular Carcinoma (HCC) Prevention and Early Detection

Chronic hepatitis B virus (HBV) co-infection is more common in HIV-infected people in the United States and in some regions of sub-Saharan Africa. In addition, HIV infection increases the risk of chronic HBV infection. HIV/HBV co-infection was associated with increased pre-cART liver mortality in comparison to infection with the two viruses alone, particularly in patients with low CD4+ T cell counts. The World Health Organization (WHO) currently recommends universal HBV vaccination for infants and young children, which has been shown to reduce the risk of infection by more than 70%. In HIV-infected patients with detectable hepatitis C virus (HCV) RNA, HCV treatment reduces the risk of liver problems. HCV-induced cirrhosis is a well-established risk factor for the development of HCC among HIV infected patients. Co-infection with HIV and HCV increased the risk of liver fibrosis and cirrhosis among pre cART patients, but cART reduced the progression of cirrhosis in patients co-infected with HIV/HCV^​1​.

Smoking cessation interventions

Incorporating smoking cessation measures into the treatment of people infected with HIV is vital. This is because HIV-infected smokers on cART are more prone to smoking associated comorbidities in comparison to those with only HIV complications. Smoking cessation measures reduce the risk of developing the most serious non-AIDS associated cancers and are likely to have additional health benefits. The most important interventions to increase smoking cessation rates are topic assessment and discussion between patients and healthcare providers. Smoking cessation programs designed for people living with HIV have also been shown to be effective in achieving this goal. Patients with HIV often face significant barriers to smoking cessation, which need to be identified and addressed to improve their chances of survival^​1​.

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