What You Should Know About HIV’s Tie to Certain Cancers
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If you have human immunodeficiency virus, or HIV, your risk of getting certain cancers is significantly higher than that of someone your age who does not have the virus, according to the National Cancer Institute (NCI). This is particularly true of people living with untreated HIV, or who aren’t taking medication to treat HIV as prescribed by a doctor. This is because untreated HIV damages the immune system, leaving the body vulnerable to other diseases, including cancer. Cancers that occur at higher rates in people living with HIV are called HIV-associated cancers.
Fortunately, progress in HIV treatment has decreased the incidence of the most common HIV-associated cancers, according to the NCI. Still, cancer remains a critical health threat for those living with the virus. Understanding your cancer risk, getting screened regularly, and staying on top of your HIV treatment are key to avoiding cancer.
Types of HIV-Associated Cancers
AIDS-Defining Cancers Three types of cancer — Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer — are considered “acquired immunodeficiency syndrome (AIDS)–defining cancers.” They are called AIDS-defining cancers because once someone with HIV develops any of these cancers, it confirms they have AIDS. While HIV is the virus that attacks the immune system, AIDS is a diagnosed syndrome that occurs when a person with HIV has developed one or more opportunistic infections — illnesses that develop because the immune system is weakened, such as tuberculosis or salmonella infection — or because a person has a low number of CD4 cells, according to HIV.gov. CD4 cells are white blood cells that help the immune system fight infections. HIV attacks these cells.
Non-AIDS-Defining Cancers Several other types of cancers are also more common among those living with HIV, including lung, liver, anal, and certain skin cancers, along with Hodgkin lymphoma and cancers of the head and neck. These cancers do not indicate the presence of AIDS.
Both types of HIV-associated cancers are connected to viruses that take advantage of the weakened immune systems in people with untreated HIV, leading to these malignancies.
What Makes People With Untreated HIV Prone to Certain Cancers?
While the factors behind this elevated cancer risk can vary, the main reason people with untreated HIV are at greater risk for certain cancers is because of viruses, explains Marco Ruiz Andia, MD, the chief of HIV oncology and HIV stem cell transplantation with Miami Cancer Institute.
According to Dr. Ruiz Andia, these viruses include:
Kaposi sarcoma–associated herpesvirus (KSHV), also called human herpesvirus 8 (HHV-8), which can lead to Kaposi sarcoma.
Epstein-Barr virus (EBV) — a type of herpesvirus also known as herpesvirus 4 — which can cause non-Hodgkin lymphomas. Hodgkin lymphoma, a non-AIDS-defining cancer, is also often linked to EBV, according to the ACS.
Human papillomavirus (HPV), which can lead to cervical cancer. HPV is also linked to cancer of the anus and some cancers in the back of the throat, base of tongue, and tonsils (oropharyngeal cancer).
When these viruses are present in the body and interact with the HIV virus, they trigger certain changes in the cells that can lead to the development of cancer, Ruiz Andia says. And, according to the ACS, both people with and without HIV are at risk of developing cancer from these viruses. But the risk may be higher in those with untreated HIV who have weakened immune systems and an inability to fight viral infections that can cause cancer.
In addition to these viruses, HIV itself can harm the immune system and cause persistent inflammation, potentially leading to an increased risk of cancer, per the ACS.
People living with HIV have higher rates of alcohol and substance use disorders, the ACS notes, and are estimated to smoke tobacco at twice the rate as those who do not have HIV, according to HIV.gov. Tobacco use can cause many types of cancers, per the CDC, while a 2021 study published in Lancet Oncology noted that alcohol consumption is linked to multiple cancers.
Antiretroviral Therapy’s Impact on Cancer Risk for People With HIV
Compared with the general population, people with HIV are about 500 times more likely to develop Kaposi sarcoma, nearly 12 times more likely to get non-Hodgkin lymphoma, and about three times more likely (among women) to develop cervical cancer, according to a study in Lancet HIV.
But advancements in HIV treatment seem to have made a change in cancer diagnoses for those living with HIV. “There has been a clear shift from the early days of the HIV epidemic, where AIDS-defining cancers were the most common cancers seen among people with HIV (PWH),” says Brinda Emu, MD, the director of the Yale Cancer Infectious Diseases Program and a member of Yale Cancer Center. The rate of AIDS-defining cancers has decreased while there’s been an increase in non-AIDS-defining cancers, according to Dr. Emu.
The probable reason for this shift is the introduction of combination antiretroviral therapy (cART), according to the NCI. CART uses a combination of three or more drugs to treat HIV and reduce the amount of circulating virus in the blood, helping to lessen the damage caused by HIV to the immune system and slow down the progression to AIDS, according to the NCI.
Despite a lower risk than in the past, the likelihood of developing one of the AIDS-defining cancers remains significantly higher among people with untreated HIV than in the general population, per the NCI.
When it comes to the increase in non-AIDS-defining cancers, the NCI attributes it to cART reducing the number of deaths from AIDS and allowing more people with HIV to live longer. As people with HIV live longer, they tend to develop the types of cancers often seen later in life, such as lung, liver, and other non-AIDS-defining cancers. According to a 2021 review published in Lancet Oncology, researchers predict that by 2030, prostate cancer (a type of cancer commonly diagnosed in men over age 65) will be the most common cancer in people with HIV, followed by lung cancer.
Treating Cancer in People With HIV
Cancer treatment options depend on the type of cancer you have, the stage of your cancer, your overall health, and your preferences. The cancer treatments used for people living with HIV are similar to those used for people without HIV. These may include one or more of the following:
Chemotherapy Treatment that uses anti-cancer medications to kill cancer cells
Radiation therapy Use of high-energy rays to kill and shrink cancer cells
Surgery Removal of cancerous tissue from the body
Immunotherapy Treatment that boosts the immune system to fight cancer
Targeted therapy Treatment that targets gene abnormalities that make cancer cells grow
But there are some important considerations. Emu says chemotherapy and radiation therapy can weaken the immune system. “Therefore, close attention needs to be paid to the impact of treatment on [CD4] cell counts,” she says.
Emu says PWH undergoing cancer treatment may need to take prophylactic medications to prevent opportunistic infections. Your cancer care team and infectious disease healthcare providers will also closely monitor you for side effects and interactions between cancer treatments and antiretroviral therapy, explains Emu.
Another treatment option is clinical trials, which are used for all types and stages of HIV-related cancers, Emu adds. Clinical trials help researchers evaluate whether a new treatment or medication is effective and safe.
Historically, people with HIV have been excluded from clinical trials, Emu notes, adding that this exclusion has led to little guidance on whether cancer treatment itself needs to be modified in PWH. You can take an active role by asking your cancer care team about open clinical trials you may qualify for.
How People With HIV Can Reduce Their Cancer Risk
If you are living with HIV and are concerned about developing an HIV-associated cancer, there are steps you can take to reduce your risk.
Take your antiretroviral therapy. “The most important modifiable risk factor among PWH is to remain adherent to antiretroviral therapy (ART),” Emu says. Staying adherent with ART helps you manage your HIV. This, in turn, decreases the risk you’ll develop AIDS and cancer.
Adopt a tobacco- and alcohol-free lifestyle. You can significantly lower your risk by steering clear of tobacco, secondhand smoke, and alcohol, Emu explains.
Get vaccinated. Emu recommends talking to your healthcare provider about receiving vaccines against viruses that can cause cancer. These include the HPV and hepatitis B vaccines for people who are not vaccinated or already have these viruses.
Get tested and treated for hepatitis C. About 1 in 4 PWH in the United States have hepatitis C, according to HIV.gov. If you have hepatitis C, treatment may reduce your cancer risk, Emu says. Chronic hepatitis C virus (HCV) infection is a risk factor for liver cancer. So, for people living with HCV and HIV, treatment for HCV can reduce their risk of developing liver cancer.
Stay on top of cancer screening. “[People with HIV] should be involved in comprehensive cancer screening programs,” Ruiz Andia says. Regular screening can catch cancers early before they spread.
Cancer Screening for People With HIV
No screening tests are available to detect Kaposi sarcoma and non-Hodgkin lymphoma at early stages, according to the ACS. But if you have HIV, the ACS recommends regular checkups with your healthcare providers, and ask what cancer screening schedule is right for you based on your age, health history, and other risk factors.
Discuss cervical cancer screening with your healthcare provider. According to the ACS, screening for cervical cancer starts at age 25 for people who don’t have HIV. But cervical cancer screening should be initiated as soon as you are diagnosed with HIV. Because of the increased risk of cervical cancer and fast cancer growth rate, the recommendation is for women with HIV to undergo cervical cancer screening every year, Emu says.
At present, there isn’t consistent guidance for screening the general public for anal cancer. Per the ACS, certain people at a higher risk for anal cancer and precancerous conditions — like anal intraepithelial neoplasia (AIN) — should be screened for the disease. The ACS notes this group includes men who have sex with men regardless of HIV status; women with a history of cervical, vaginal, or vulvar cancer; people living with HIV; and those with weakened immune systems.
For people at high risk of anal cancer, experts recommend regular screening through anal cytology testing, also called an anal Pap test. In the case of at-risk individuals who have HIV, some experts suggest getting an anal Pap test every year.
