People living with HIV/AIDS (PLWHA) have historically had a higher risk of developing cancer. In the earlier years of the HIV epidemic, several types of cancer, far more common among PLWHA than the general population, came to be known as AIDS-defining cancers and included non-Hodgkin lymphoma, kaposi sarcoma, and invasive cervical cancer3.
Since the introduction of antiretroviral medications (HAART) in the mid 1990’s, the life expectancy of PLWHA has greatly improved1. However, now that PLWHA are less likely to die from HIV disease, there is a growing concern about other health threats2. , approximately 25% of all AIDS deaths are due to nonHIV-related causes, and certain cancers account for a great deal of this mortality6.These cancers, called AIDS-associated cancers or non-AIDS defining cancers, have dramatically increased in prevalence in long-term survivors of HIV/AIDS and include4,5.
- Lung cancer
- Anal cancer
- Liver cancer
- Colorectal cancer
- Testicular cancer
In fact, today, anal and lung cancer are more prevalent among HIV-infected patients than non-HIV patients33.
The exact cause of the increase in these cancers is not known, but many factors disproportionally present in PLWHA appear to increase their risk. Studies report that a CDC count below 50028, associated with an HIV compromised immune system, may account for some of the increase in the incidence of these cancers. Anti-retroviral medications themselves may also be a factor. Infection with Human Papillomavirus (HPV), much more common in PLWHA, has also been linked to increased cancer risk. However, race, socio-economic status and behaviors play a large, underrecognized part in increasing the risk of cancer in PLWHA.
For example, smoking rates in PLWHA are very high, putting these individuals at greater risk for tobacco-related cancers. Studies estimate that 45-74%7-17 of PLWHA use tobacco, as compared to 19.8% of the general population18. Poverty also adds to the cancer risk19-23. The Center for Disease Control24 estimates that 57.1% of PLWHA have annual incomes below $10,000, and 67.4% are unemployed. These rates of HIV infection are disproportionately elevated among low income African Americans and Hispanics/Latinos24-26, a vulnerable population that experiences other cancer health disparities as well27.
Regardless of the type of non-AIDS-defining cancer, the course of the disease tends to differ for PLWHA compared to the general population. cancer is often diagnosed at a much younger age30, as seen in lung and testicular cancers31,32, and tends to be diagnosed at a more advanced stage, leading to worse prognosis29. Treatment is complicated by potential drug interactions with HIV mediations.
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