HIV and Cancer

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 non HIV-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.

For more information, browse any of the articles below.

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  3. CDC, 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Morbidity and Mortality Weekly Report, 41;961-962. 1992.
  4. Engels, E.A., et al., Cancer risk in people infected with human immunodeficiency virus in the United States. International journal of cancer, 2008. 123(1): p. 187-94.
  5. Patel, P., et al., Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992-2003.Annals of Internal Medicine, 2008. 148(10): p. 728-36.
  6. Sackoff, J.E., et al., Causes of death among persons with AIDS in the era of highly active antiretroviral therapy: New York City. Ann Intern Med, 2006. 145(6): p. 397-406.
  7. Tesoriero, J.M., et al., Smoking Among HIV Positive New Yorkers: Prevalence, Frequency, and Opportunities for Cessation. AIDS Behav, 2008. In press.
  8. Webb, M.S., et al., Cigarette smoking among HIV+ men and women: examining health, substance use, and psychosocial correlates across the smoking spectrum. Journal of Behavioral Medicine, 2007. 30(5): p. 371-83.
  9. Engels, E.A., et al., Elevated incidence of lung cancer among HIV-infected individuals. Journal of Clinical Oncology, 2006. 24(9): p. 1383-8.
  10. Burkhalter, J.E., et al., Tobacco use and readiness to quit smoking in low-income HIV-infected persons. Nicotine Tob Res, 2005. 7(4): p. 511-22.
  11. Miguez-Burbano, M.J., et al., Increased risk of Pneumocystis carinii and community-acquired pneumonia with tobacco use in HIV disease. International journal of infectious diseases, 2005. 9(4): p. 208-17.
  12. Crothers, K., et al., The impact of cigarette smoking on mortality, quality of life, and comorbid illness among HIV-positive veterans. Journal of general internal medicine, 2005. 20(12): p. 1142-5.
  13. Gritz, E.R., et al., Smoking behavior in a low-income multiethnic HIV/AIDS population. Nicotine & Tobacco Research, 2004. 6(1): p. 71-7.
  14. Mamary, E.M., D. Bahrs, and S. Martinez, Cigarette smoking and the desire to quit among individuals living with HIV. AIDS Patient Care STDS, 2002. 16(1): p. 39-42.
  15. Collins, R.L., et al., Changes in health-promoting behavior following diagnosis with HIV: prevalence and correlates in a national probability sample. Health Psychology, 2001. 20(5): p. 351-60.
  16. Turner, J., et al., Adverse impact of cigarette smoking on dimensions of health-related quality of life in persons with HIV infection. AIDS Patient Care STDS, 2001. 15(12): p. 615-24.
  17. Niaura, R., et al., Smoking among HIV positive persons. Annals of Behavioral Medicine, 1999. 21 (Suppl): p. S116.
  18. CDC, Cigarette smoking among adults–United States, 2007, in Morbidity and Mortality Weekley Report. 2008. p. 1221-1226.
  19. Fife, D. and C. Mode, AIDS incidence and income. Journal of acquired immune deficiency syndromes, 1992. 5(11): p. 1105-10.
  20. Hu, D.J., et al., The expanding regional diversity of the acquired immunodeficiency syndrome epidemic in the United States. Arch Intern Med, 1994. 154(6): p. 654-9.
  21. Morse, D.L., et al., Geographic distribution of newborn HIV seroprevalence in relation to four sociodemographic variables. Am J Public Health, 1991. 81 Suppl: p. 25-9.
  22. Simon, P.A., Income and AIDS rates in Los Angeles County. AIDS, 1995. 9(3): p. 281.
  23. Zierler, S., et al., Economic deprivation and AIDS incidence in Massachusetts. American Journal of Public Health, 2000. 90(7): p. 1064-73.
  24. Centers for Disease Control and Prevention, Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; Special Surveillance Report No. 2: [Table 2], 2004.
  25. Bishaw, A. and J. Iceland, Poverty: 1999. Census 2000 brief. Washington, DC: U.S. Census Bureau; 2003. 2000.
  26. Dray-Spira, R., A. Gueguen, and F. Lert, Disease severity, self-reported experience of workplace discrimination and employment loss during the course of chronic HIV disease: differences according to gender and education. Occupational and environmental medicine, 2008. 65(2): p. 112-9.
  27. ACS (2008) Cancer Facts & Figures 2008. American Cancer Society.
  28. Low CD4 Cell Count Elevates Cancer Risk in Patients with HIV. Reuters Health Medical News. October 7, 2009.
  29. Tirelli U, Spina M, Sandri S, et al. Cancer. 2000;88:563-569.
  30. Demopoulos BP, Vamvakas E, Ehrlich JE, Demopoulos R. Arch Path Lab Med. 2003;127(5):589-592.
  31. Powles T, Bower M, Daugaard G, et al. J Clin Oncol. 2003;21(10):1922-1927.
  32. Tirelli U, Spina M, Sandri S, et al. Cancer. 2000;88:563-569
  33. Article URL: