Prior to the breakthroughs of the ‘90s, the cancers most associated with AIDS were those that defined an AIDS diagnosis: Kaposi’s sarcoma, cervical cancer, and non-Hodgkin’s lymphoma.
Since those breakthroughs, new cases of AIDS defining cancers have declined, at least for people in treatment. Now, however, other cancers have increased among the HIV Infected. Researchers have named them Non AIDS-Defining Cancers (NADC).
According to researcher James Goedert, the following NADC occur among HIV infected people: Hodgkin’s lymphoma, anal cancer, liver, and lung cancer. In the U.S., about half the cases of lung cancer, the overwhelming majority of the cases of Hodgkin’s lymphoma, and almost all cases of anal cancer occur among the HIV infected. As people age, the risk for an NADC increases. The 2015 Conference on Retroviruses and Opportunistic Infections (CROI) presented a great deal of research on these NADC. Two will be discussed below: lung cancer and anal cancer.
HIV positive smokers have a high risk for developing lung cancer, according to researcher Keri Althoff. She reported that preventing smoking initiation could reduce NADC by 37 percent. She recommended HIV specific anti-smoking interventions.
Researcher Keith Sigel reported on the relationship between CD4 counts and the risk for developing lung cancer. While people with a CD4 count of less than 500 cells have a greater risk for lung cancer, they have similar survival rates to people uninfected with HIV.
HIV infected people have substantial risks for anal and cervical cancer. Researcher Gypsyamber D’Souza reported that human papilloma virus (HPV) has more than 100 distinct subtypes. About fifteen HPV subtypes cause cancers of the anus, penis, vagina, cervix, and oral cavity. Other HPV subtypes cause genital warts. While some HPV subtypes can lead to anal and oral cancers, anal cancer occurs more frequently than oral cancer among HIV infected gay and bi men.
According to a report from Project Inform, the HPV subtypes that cause genital warts will not lead to cancer. Most people can clear HPV within six months of the initial infection. People living with HIV have a higher risk for acquiring HPV, for stubborn symptoms, and for higher rates of cervical and anal dysplasia, a condition with a high risk for cancer development. Sexually active gay and bisexual men have 17 times higher risk of anal dysplasia and cancer, a result of higher rates of HPV infection.
The Centers for Disease Control (CDC) reports that HPV transmission occurs more frequently than any other STD, with about 14 million new HPV infections each year . Most sexually active people will get at least one type of HPV at some point in their lives. An HPV vaccine exists for the subtypes that cause cancer. Vaccinating the already infected, however, only benefits pharmaceutical companies. As a result, eligibility for this vaccine is restricted to the following groups: 1) males and females aged 11 or 12; 2) all males up to 21; and 3) all females, gay bi men, and all people infected with HIV up to age 26.
HPV has serious consequences for the HIV infected. Some doctors recommend an anal pap smear for gay bi men at least once every three years. ARV treatment, HPV vaccination, and smoking cessation can significantly lessen the dangers of anal and lung cancers. We still do not have an HIV cure. We only have ways to lessen its effects and to prevent it.
Many of the presentations of the CROI conference are available on line. To view them please visit www.croiwebcasts.org/
For Project Inform’s report on HPV, please visit www.thebody.com/content/art48935.html
For the CDC’s report on HPV, please visit /www.cdc.gov/STD/HPV/STDFact-HPV.htm and www.cdc.gov/std/hpv/hpv-factsheet-march-2014.pdf