by Mona Jhaveri - January 11, 2022

Worldwide, approximately 37.7 million people are living with HIV, and 1.2 million out of those living in the United States.

Since discovering HIV and AIDS, there has been an onslaught of misconceptions about the disease, starting from the widespread belief that AIDS is caused only by gay sex or intravenous drug use. Although these are risk factors, they are not the only ones. HIV can be transmitted by any sexual contact with an infected partner, as well as through blood transfusions and mother-to-child transmission during pregnancy or birth.

An important fact is that HIV-positive individuals are more at risk for certain types of cancer.

This blog post will discuss the most common types of cancer found among HIV-positive patients and treatments and prevention strategies.

HIV, A Breakdown

The human immunodeficiency virus (HIV) is the virus that causes AIDS (acquired immune deficiency syndrome). HIV is spread through bodily fluids, most commonly during unprotected sexual intercourse or sharing needles.

HIV infects specific cells of the immune system called CD-4 lymphocytes or T-helper cells. These are important because they help fight infections and cancer; therefore, when HIV destroys them, the immune system is weakened and can’t fight off other infections or cancers.

Cancers linked to HIV infection are collectively called HIV-associated cancers.

They can be divided into AIDS defining-cancers and non-AIDS defining-cancers.

AIDS-Defining Cancers

AIDS-defining cancers occur in people whose HIV infection has progressed to AIDS. These cancers include:

  • Kaposi’s sarcoma (KS)

KS is a type of cancer that causes lesions on the skin or internal organs. It is usually associated with a virus called human herpesvirus 8 (HHV-8), which is also the cause of genital herpes. This virus typically doesn’t cause disease or cancer in healthy people, but when the immune system is weakened because of HIV infection, it can cause problems. KS was one of the first signs that AIDS existed and has long been linked to poor health in patients with advanced stages of HIV or AIDS. An HIV-positive person is 500 times more likely to develop KS than an HIV-negative person.

  • Non-Hodgkin lymphoma (NHL)

NHL is a cancer of the lymph nodes, part of the immune system. It can affect both HIV-positive and negative individuals. It’s important to note, most NHL patients are not HIV positive.

However, given how there are many types of non-Hodgkin lymphoma, HIV-positive patients typically develop more aggressive forms of the disease, such as Burkitt lymphoma, primary central nervous system lymphoma, and aggressive B-cell NHL. HIV-positive individuals are 12 times more likely to be diagnosed with NHL.

  • Cervical cancer

Cancer of the cervix is the fourth most common type of cancer found in women worldwide. It is caused by the human papillomavirus (HPV), a sexually transmitted virus. HPV is very common and can be contracted by both men and women. Most people who have HPV don’t develop cervical cancer. Still, for HIV-positive patients, it is a more serious risk – HIV-positive women have three times more chance of developing cervical cancer compared to HIV-negative women.

Non-AIDS-Defining Cancers

A range of other cancers have a higher incidence in HIV-positive patients than the general population, but they are not limited to those with advanced HIV or AIDS. These non-AIDS-defining cancers include:

  • Anal cancer
  • Hodgkin lymphoma
  • Liver cancer
  • Lung cancer
  • Mouth and throat cancers

Cancer Death Risk

In addition to having a higher risk of developing specific cancers, those living with HIV also have a higher chance of dying from cancer. Reasons for this are still not fully understood, but one of the major contributing factors is the weakened immune system.

Studies also suggest that most HIV-positive patients don’t have the same access to cancer care as HIV-negative patients. This may be because of the social and economic disparities between these groups or because of a lack of knowledge about cancer among healthcare providers who treat people with HIV.

These factors together mean that those living with HIV are more likely to die from cancer than those without the virus.

HIV and Cancer Treatment

Nowadays, if cancer is diagnosed in a person with HIV, treatment options are usually the same as for any other patient. However, that was not always the case.

Before the advent of combination antiretroviral therapy (cART) in the mid-90s, the prognosis of HIV-positive patients with cancer was extremely poor. This is because HIV infection itself had a damaging effect on the immune system, which would not be able to fight against developing cancer cells properly.

Moreover, healthcare professionals often opt for lower doses of chemotherapy and radiotherapy drugs due to concerns about their toxicity in people with HIV. This reduced the effectiveness of cancer treatment, further worsening the prognosis for these patients.

Thankfully, this has changed thanks to cART – since 1996; there have been many advances that allow doctors to better manage both conditions simultaneously by using potent anti-HIV therapy combined with effective cancer treatment.

Here are the most common methods used for treating AIDS-defining cancers.

Kaposi’s Sarcoma Treatment

If the patient diagnosed with Kaposi Sarcoma isn’t on antiretroviral therapy yet, it should be started immediately to improve their prognosis. For some patients, starting cART could be enough to remove the KS lesions completely. However, if this is not possible or their condition does not improve with cART alone, other therapies such as surgery, chemotherapy, or photodynamic therapy may be used.

Two types of surgery commonly used for treating KS lesions are curettage with electrodesiccation and cryosurgery – both involve cutting out the lesions. In the case of curettage, the lesion is scraped with a sharp instrument (curette) to remove it. Cryosurgery uses liquid nitrogen to freeze and destroy the lesion.

Chemotherapy for KS can be either systemic or local – systemic chemotherapy involves taking drugs orally or by injection that travels through the entire body and kills cancer cells wherever they are. Local chemotherapy is given directly to the lesion (as an intralesional injection) and can be used either as a primary treatment or with other therapies.

Photodynamic therapy (PDT) involves shining a light on the lesion after applying a photosensitizing drug. This makes the lesion sensitive to light and kills cancer cells when exposed to a laser or white light.

Non-Hodgkin Lymphoma Treatment

Treatment for NHL most often involves a combination of chemotherapy and radiation therapy. Targeted therapy is also an option for some patients.

Immunotherapy drugs such as rituximab can also be used to treat NHL. These drugs work by targeting and attacking the cancer cells specifically, without harming the healthy cells in the body.

Cervical Cancer Treatment

HIV-positive women with cervical cancer are usually treated with the same methods as HIV-negative women. This includes surgery, chemotherapy, radiation therapy, and targeted therapy.

There are many different types of surgery that can treat cervical cancer. The most common is a hysterectomy – this involves removing the uterus. Other surgeries include the removal of just the cancerous cells (conization).

In chemotherapy, cisplatin and paclitaxel are commonly used to treat early-stage cancers. Cisplatin can be given orally or intravenously, whereas paclitaxel is given intravenously. Radiation therapy is usually given as external beam radiation. The patient sits or lies down on a treatment table, and a large machine moves around them, directing beams of radiation at the cancer cells.

Targeted therapies such as bevacizumab and cetuximab can also be used to treat cervical cancer.

Treatment Selection

Given the complexity of treating HIV-associated cancers, patients need regular assessments from a multidisciplinary team of cancer and HIV experts. This involves oncologists (cancer doctors), radiation therapists, medical oncologists/hematologists (doctors specializing in treating blood disorders), infectious disease specialists (including an HIV specialist), nurse care coordinators, physical therapists, social workers, and psychologists.

The treatment that’s right for you will depend on several factors – the stage of your cancer (is it early or late), how well certain treatments have worked in other patients with similar conditions, whether you’re able to handle specific drug therapies due to age or medical problems, etc. Both doctors and patients need to work together to understand their diagnosis and treatment options.

Your doctors will carefully monitor your progress and side effects throughout the treatment. This could involve regular blood tests, chest X-rays, CT scans of the brain or abdomen, stool samples to check for cancer cells in your colon (which can be a sign of liver disease), etc. They will ensure that your T-cell levels are stable, as these are an important marker of how well your HIV is being controlled.

You should also be aware of clinical trials – these are research studies involving new ways of treating cancer. They may compare an experimental therapy with standard treatments to find out which works best for certain cancers or types of people. You can search for current clinical trials online or ask your doctor if there are any trials that might be a good fit for you.

HIV and Cancer Risk

The reason why HIV-infected people have a higher risk of certain cancers is multifold. One reason is that viruses cause many cancers, and HIV can cause an immune system to be weakened – making it easier for the virus to develop.

Another side of the same coin is lifestyle risk factors. People with HIV are more likely to smoke. ART largely put the HIV wasting syndrome under control, but it led to increased obesity and diabetes.

If you are HIV positive, it is imperative to do your best to lower your chances of developing cancer.

Here are the most important steps you can take to reduce your risk.

Take HIV medications regularly

According to research, HIV-positive individuals who start their cART treatment immediately after diagnosis have a significantly reduced risk of developing cancer – up to 64%

Take your HIV medications as prescribed, and do not miss doses, even if you’re feeling better and don’t think they’re necessary anymore.

Adherence to cART is crucial – it reduces the amount of the virus in the body (viral load), decreases cell-to-cell transmission of the virus, and helps preserve the immune system.

Look out for other viral infections

Because the immune system of HIV-positive people is weakened, they are more susceptible to other infections. This includes viruses that can cause cancer, such as HPV and Epstein-Barr virus (EBV).

Hepatitis B and hepatitis C viruses also increase the risk of liver cancer.

Be sure to get vaccinated against HPV and other common infections – this will help protect you from developing cancer caused by these viruses.

Get screened regularly

Regular cancer screening is essential not only for HIV-positive people but for everyone.

Screening tests can find cancer early when it is more likely to be treated successfully. They can be done by a medical professional, for example, a doctor or nurse.

It is also important to know your own body and be aware of changes in symptoms consistently over time – this includes new lumps, pains that won’t go away, unexpected bleeding from the rectum or vagina, or even unexplained weight loss. Report any such symptoms you notice to your health care provider as soon as possible.

HIV-positive patients should be particularly careful to report any unusual lumps, pains, or other symptoms in their breasts and testicles – this helps doctors monitor for cancer early on through appropriate biopsies and imaging.

Stop smoking

According to science, in the United States, the HIV-positive population has a 2 to 3 times higher smoking rate than the general public. This makes HIV-positive people more likely to develop certain cancers, including lung cancer and head/neck cancer.

Smoking increases your risk for several types of cancer by damaging DNA in cells throughout the body – not just those associated with cigarette use (such as lungs).

Cutting back on or quitting cigarettes can dramatically reduce your risk of developing cancer, as well as a variety of other health conditions.

It is important to consult with your doctor before quitting smoking – there are many strategies and medications to help you quit for good!

Be careful in the sun

An HIV patient has about two times more chance of developing non-melanoma skin cancer (NMSC) than a person without HIV.

There are two primary types of NMSC: basal cell and squamous cell carcinomas. Being exposed to the sun can put you at risk for all of them.

When going outside, be sure to wear SPF 30 or higher sunscreen, protective clothing, and a hat. Seek shade when possible, and avoid sunbathing and tanning beds.

If you have any suspicious skin lesions, report them to your health care provider for evaluation.

HIV-positive people should be particularly diligent about checking their skin regularly for changes – this can help catch cancer early on.

Maintain a healthy lifestyle

Ensuring your immune system is as healthy as possible is one of the best ways to prevent cancer. It is not only related to regularly taking your prescribed HIV medication.

A healthy lifestyle includes a balanced diet, exercise, and enough sleep. Avoid alcohol and tobacco products, and limit your exposure to environmental toxins.

All of these factors work together to keep your body as healthy as possible, which helps protect you from developing cancer.

Don’t forget about mental health

Facing two challenging diseases at the same time can be overwhelming. It is important to remember to take care of your mental health, in addition to your physical health.

There are many ways to do this, including talking with a counselor, joining a support group, or simply writing in a journal. Don’t hesitate to ask for help if you feel overwhelmed or like things are getting too tough to handle.

There is no shame in seeking help – it shows that you are strong and willing to do whatever it takes to live a healthy life, both physically and mentally.

Conclusion

Cancer is a difficult disease for anyone to face, but HIV-positive patients often have an added challenge. Science has confirmed that HIV-positive people are more likely to develop cancer, especially certain AIDS-defining cancers.

Thanks to advanced HIV treatment, cancer treatment in HIV-infected individuals is not that different from cancer treatment for non-HIV infected individuals. It includes all standard treatment options, such as surgery, chemotherapy, and radiation therapy.

However, during cancer treatment, medical professionals are also tasked with monitoring the patient’s HIV status and ensuring that the treatment does not cause more damage to the immune system.

There are many ways for HIV-positive people to lower their risk of cancer, including stopping smoking, being careful in the sun, and maintaining a healthy lifestyle. It is important to talk with your healthcare provider about what options are available.

Don’t neglect the importance of taking regular HIV medication, getting screened for cancer regularly, and taking care of your mental health. You can live a long and healthy life with proper care, despite being HIV positive.

Unfortunately, science has not yet progressed enough to safely say that HIV-related cancers are entirely curable. More R&D is needed to improve care for all those battling cancer. Music Beats Cancer supports innovators who are working on badly needed solutions for cancer. Please donate today if you’d like to join the fight against cancer and help us get more treatments and clinical tools to those in need.

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