HIV stands for human immunodeficiency virus. It infects the body’s immune cells and, over time, can result in acquired immunodeficiency syndrome (AIDS), a chronic and life-threatening condition. AIDS is the most advanced stage of HIV infection.
The link between HIV and cancer
HIV attacks the immune system of the body. A weaker immune system is not able to fight diseases like cancer. People with HIV often have weakened immune systems, making them vulnerable to cancer.
Here are some reasons why cancer seems to be more common among people with HIV:
People with HIV and AIDS live longer
People with HIV and AIDS live longer. HIV medications help people with HIV live longer, healthier lives. But their immune systems do not fully develop. As people with HIV live longer, their chances of having other health problems also increase.
HIV and other viruses work together
HIV and other viruses work together. This makes them vulnerable to getting cancer. Once cancer begins in people with weak immunity, it grows faster than healthy people. Some of these viruses are:
Human Papillomavirus (HPV)
Hepatitis B and Hepatitis C
Epstein-Barr Virus (EBV)
Herpes
Smoking
Smoking is common among people with HIV. Smoking is another risk factor for different types of cancer. As people with HIV live longer and continue to smoke, they increase their risk of developing smoking-related cancers.
The common types of HIV-related cancers
Kaposi’s Sarcoma, non-Hodgkin’s lymphoma, and cervical cancer (in women) are common among HIV patients. These are known as AIDS-related cancers because they occur more often in people with immune systems weakened by HIV/AIDS. Here are some facts about these cancers:
Kaposi’s Sarcoma
Kaposi sarcoma specifies that the HIV infection is in the advanced stages. Current evidence suggests that HIV-infected people have a 500 times higher risk of developing Kaposi sarcoma than common people.
Kaposi sarcoma is cancer primarily in the cells lining the lymph vessels and blood. It generally appears as a tumor on the mucosal surfaces or skin. These tumors may also develop in other body parts, such as the lungs and the digestive tract.
Causes and Symptoms
Kaposi sarcoma is caused by human herpesvirus 8 (HHV-8). Healthy people usually have a robust immune system and can fight HHV-8 infection. On the other hand, in immune-compromised conditions, such as HIV or AIDS, HHV-8 infects the cells, multiplies abnormally and has the potential to trigger Kaposi’s Sarcoma through an unknown mechanism.
Kaposi sarcoma usually appears as brown, red, or purple, coloured lesions on the skin, usually on the face and legs. These lesions do not cause any symptoms but may become a concern. In some cases, these lesions may cause painful swelling of the feet and legs.
Diagnosis
A biopsy is done to diagnose Kaposi sarcoma. If internal Kaposi sarcoma is suspected, then fecal occult blood test, chest X-ray, bronchoscopy, upper endoscopy, and colonoscopy are recommended.
Non-Hodgkin’s Lymphoma
The risk of non-Hodgkin’s lymphoma is 12 times more in HIV-infected people than in healthy people. Similar to Kaposi sarcoma, non-Hodgkin’s lymphoma is also a condition that suggests the transition of HIV to the advanced stage.
Causes and Symptoms
Non-Hodgkin’s lymphoma develops due to the overproduction of abnormal lymphocytes in the body. Slowly, these abnormal lymphocytes grow and divide, accumulating in the lymph nodes. Therefore, swollen and painless lymph nodes in the neck, armpits, or groin region are one of the most common symptoms of non-Hodgkin’s lymphoma.
The symptoms of non-Hodgkin’s lymphoma include pain or swelling in the abdomen, anemia, chest pain, cough, trouble breathing, fever, itchy skin, loss of appetite, night sweats, unexplained weight loss, weakness and fatigue.
Diagnosis
A physical examination is done to determine the size and condition of the lymph nodes. Additionally, laboratory tests, such as blood tests, are done to rule out other conditions.
Imaging tests, such as X-rays, CT scans, MRI scans, PET scans, lymph node biopsy, bone marrow aspiration and biopsy are done to diagnose the stage and extent of cancer.
Cervical Cancer
Women with HIV infection have a three times higher risk of being diagnosed with cervical cancer than their healthy peers.
Causes and Symptoms
Although the exact reason for cervical cancer is not known, scientists believe it occurs due to DNA mutations in the cells lining the cervix. Some factors such as human papillomavirus (HPV) infections, smoking, becoming sexually active at a young age, and a weakened immune system may increase the risk.
Cervical cancer may not cause any signs or symptoms during the early stages. However, in some cases, it may typically cause the following symptoms:
- Bleeding after douching and sexual intercourse
- Bleeding after menopause
- Irregular or abnormal bleeding between periods
- Longer or heavy menstrual bleeding than usual.
- Pain during intercourse
- Watery, bloody vaginal discharge that may be heavy and have a foul odor
- Unexplained persistent pelvic pain or severe back pain
Diagnosis
A routine pelvic examination is done to look for any unusual changes. In addition, the patient’s overall health and medical and personal history are evaluated. To confirm the diagnosis, some laboratory tests like blood tests, including routine blood work-up and renal function tests, colposcopy, biopsy, imaging tests like CT scan, MRI scan, PET CT and liver function tests are recommended to determine the extent of disease spread.
Other HIV-related cancers
HIV-infected people are at a higher risk of developing the following non-AIDS defining cancers (NADCs) when compared to non-HIV infected people:
19 times higher risk of anal cancer
3 times higher risk of liver cancer
2 times higher risk of lung cancer
2 times higher oral and oropharyngeal cancer
8 times more likely to develop Hodgkin’s lymphoma
Risks factors for cancer in HIV patients
The compromised immune system is a significant risk factor for cancer in HIV patients. Also, the progression of cancer cells is much faster in HIV-infected people than in HIV-uninfected people.
HIV-infected persons are more likely to be infected with the oncogenic viruses (cancer-causing viruses) than people in the general population like Kaposi sarcoma-associated herpesvirus(KSHV), Human herpes virus(HHV-8) that can cause Kaposi sarcoma and some subtypes of lymphoma. Epstein Barr Virus (EBV) can cause some subtypes of Hodgkins Lymphoma and Non-Hodgkins Lymphoma, Human papillomaviruses(HPV), which can cause cervical cancers, anal cancer, and oropharyngeal, penile, vaginal and vulval cancer, Hepatitis B virus(HBV) and Hepatitis C virus (HCV), which both causes liver cancer.
Additionally, the traditional risk factors contributing to the development of cancers in HIV are tobacco smoking and heavy alcohol consumption.
Measures to reduce the risk factors
The following measures may help in reducing the risk of HIV-related cancers:
Combination antiretroviral therapy (CART): According to HIV treatment guidelines, taking CART therapy reduces the risk of Non-Hodgkin Lymphoma and Kaposi sarcoma. It also improves the overall survival rates.
Knowing the status of viral hepatitis: HIV-infected people are more prone to infections, especially viral infections. They also have a higher risk of liver cancer. So, it is advisable to check their hepatitis status regularly and take both HBV suppressing agents and CART therapy. It can help lower the liver cancer risk.
- Screening for cancers: Screening is always a solution to diagnose and treat cancers at an early stage. HIV-infected patients should undergo regular screening to check for AIDS-related and other cancers. For example, screening for cervical cancer using pap smear cytology.
- Smoking cessation: HIV-infected people are at a higher risk of lung, oral, and other cancers associated with smoking. Therefore, smoking cessation could be a great way to reduce its risk.
Avoiding/limiting alcohol intake may help lower the risk of some cancers.
Some types of cancers linked with HIV and AIDS are caused by viruses that can be spread through sex, so safer sexual practices may also help protect against those cancers. Being physically active, maintaining a healthy weight, and eating a balanced nutritious diet may help lower a person’s cancer risk.
Treatment for HIV and cancer
Those with HIV already have a weak immune system even before they start cancer therapy. This factor makes cancer and HIV treatment more complex. Therefore, several factors, such as the type of cancer, stage of cancer, immune system function, response to treatment, and overall health status of the patient, are considered while treating cancer coexisting with HIV.
The cancer treatment is usually the same in HIV uninfected and HIV infected people. Chemotherapy, radiation therapy, immunotherapy, targeted therapy, and surgery are the standard treatment options for cancer.
The anti-HIV treatment should also go hand in hand with cancer treatment for better outcomes. HIV patients on anti-HIV drugs can get a total dose of chemotherapy and other treatment options to improve overall survival rates.
However, certain modifications in the drug dose and regimen might be required depending upon the state of the immune system of HIV-infected people.
The outcome of treatment in HIV-positive patients is worse compared with HIV-negative patients, and HIV-positive patients present late and are less likely to complete oncological treatment.
Treating AIDS-defining cancers
Anti-HIV therapy is an integral part of treating AIDS-defining cancers.
Kaposi Sarcoma: Anti-HIV therapy is recommended in HIV-infected people diagnosed with Kaposi sarcoma. Anti-HIV therapy is a sufficient treatment for non-visceral diseases.
For a visceral disease with several internal lesions, chemotherapy is recommended. For locally symptomatic diseases, radiation therapy may be introduced.
Non-Hodgkin lymphoma: It is of several types, but the type which is linked to HIV is the fast-growing one and needs to be treated with intensive chemotherapy.
Usually, the treatment for non-Hodgkin lymphoma is the same as in individuals with HIV uninfected non-Hodgkin lymphoma patients. However, chemotherapy must be given with caution, and the blood counts must be monitored regularly during treatment.
Cervical Cancer: The management is similar to that in non-HIV infected women with cervical cancer. The immune status must be checked regularly along with proper treatment for HIV infection.
Women with advanced cervical cancer may not have an excellent response to radiation therapy alone. Chemotherapy is recommended in women with advanced or recurrent cervical cancer. Irrespective of the CD4 status, anti-HIV therapy must be given to improve the treatment outcomes in HIV-infected women.
Women with HIV-infected cervical cancer must be monitored regularly to ensure cancer doesn’t recur.
What can be done to lower the chances of getting cancer?
There are two ways to beat cancer.
Healthy Living and Early Detection
You can lower your cancer risk and manage your HIV at the same time by making healthy choices. Finding cancer in its early stages (early detection) and treating it right away can raise your chances of living longer with HIV. Cancer treatments can also be very hard on the immune systems of people with HIV. So, it is also essential for people with HIV not to let cancer start growing (prevention) and find cancer in its early stages.
Healthy Living to Prevent Cancer
Quitting smoking is the most significant step to protecting yourself from cancer. If you quit smoking, you can significantly lower your risk of cancer of the mouth, throat, lungs, stomach, kidneys, liver, pancreas, and bladder. As soon as you stop smoking, your body starts to heal and your cancer risk drops. Ask your doctor about treatment and counseling to help you quit.
Take all your HIV medications on schedule. A stronger immune system is your best protection against many types of cancer. Take all your medications on schedule and try not to skip doses. HIV medications have helped to reduce Kaposi’s Sarcoma significantly.
Protect yourself and others from HIV and other viruses. HIV, HPV, hepatitis and herpes are passed through sex or by sharing needles or other equipment used to inject drugs. Use a condom the right way every time you have sex. Never share needles or drugs.
