HIV Survivors Need Cancer Prevention

As HIV-infected adults live longer, they are increasingly susceptible to specific cancer types. This calls for targeted cancer prevention efforts in this population.

Progress in antiretroviral research has resulted in a dramatic improvement in outcomes for HIV patients over the years. However, a new study in the Annals of Internal Medicine shows that those who have survived the retrovirus are more susceptible to malignant disease.

The authors used data from the North American AIDS Cohort Collaboration on Research and Design, during the period between 1996 and 2009. Participants included nearly 87,000 individuals with HIV and nearly 197,000 individuals without the infection. The outcome measure of the study was cumulative incidence of cancer by age 75 years based on HIV status. When analyzed based on cancer type, the authors found that HIV infection significantly increased the patient’s susceptibility to Kaposi’s sarcoma (4.5% vs 0.01%; with and without HIV), Non-Hodgkin lymphoma (4.5% vs 0.7%), lung cancer (3.4% vs 2.8%), anal cancer (1.5% vs 0.05%), liver cancer (1.1% vs 0.4%), and Hodgkin lymphoma (0.9% vs 0.09%). The authors write that reduced mortality rate for anal, colorectal, and liver cancer may be responsible for increasing cumulative incidence with those diseases.

“Pretty much across the board, cancer incidence was higher in HIV patients,” said lead study author Michael J. Silverberg, PhD, MPH, of Kaiser Permanente Division of Research, in an interview. “With these effective therapies, HIV patients are living almost normal lifespans. Before [1996], people were dying before they were old enough to get many of these diseases.”

The authors point out that their results provide impetus to cancer prevention efforts among smokers with HIV. The increased risk for liver cancer points to the need for vaccinating HIV patients against the hepatitis B virus (HBV). Those infected with HBV should be treated with antiretrovirals against HBV.

“There’s still underlying damage to the immune system and underlying inflammation that’s causing these cancers,” Silverberg said. “Even in the treated person, there is still higher risk.