New York—Antiretroviral therapy transformed infection with human immunodeficiency virus (HIV) from a death sentence to a chronic condition, along the way changing virtually everything about the disease, including its association with cancer.
For years, specific cancers were tightly linked to the disease. Some types of cancer occurred almost exclusively in patients with HIV, such as Kaposi sarcoma. Three—Kaposi sarcoma, certain types of non-Hodgkin lymphoma (NHL), and cervical cancer—define the transition from HIV infection to full-blown acquired immunodeficiency syndrome (AIDS).
Today, the most common cancers in patients with HIV are non-AIDS defining malignancies. Recent research among veterans provides insight into how dramatically the risk and outcomes of various cancers has changed for patients with HIV.
The VA is the largest provider of healthcare services to individuals with HIV in the United States. Nearly 60,000 veterans have HIV, with most of those veterans being between the ages of 50 and 65, an age at which the risk for cancer begins to rise generally.
“As HIV treatment has gotten better, people are living longer, and age is the strongest cancer risk factor of all. So cancer burden is increasing in people with HIV but it may be due to demographic and behavioral factors,” said Keith Sigel, MD, PhD, associate professor of medicine at the Icahn School of Medicine at Mount Sinai in New York.
In addition, the VA has one of the most comprehensive databases on HIV and cancer. The Veterans Aging Cohort Study (VACS), a key source for detailed analysis, tracks the largest HIV cohort in North America. The database includes 55,986 veterans with HIV and 116,335 demographically matched and behaviorally similar comparators.
A review of literature on HIV and cancer among veterans published in Seminars in Oncology used data from national VA databases to understand more about the changes in the association between HIV and cancer in the ART era.1
“It is safe to say that cancer is a major cause of death for people with HIV and that the non-AIDS defining cancers have been increasing in incidence in this group over the last 20 years,” Sigel, the review’s lead author, told U.S. Medicine. “Cancer is the cause of about 10% to 25% of deaths for people with HIV depending on the measurement method.”
Overall, the incidence of cancer in veterans with HIV has declined since the advent of ART, but it remains higher than in veterans without HIV. Significant variations emerge when looking at specific malignancies, however, and may indicate the need for earlier detection and different approaches to treatment compared to other veterans.
Continue Reading this Article: AIDS-Defining Cancers
