Other Cancers
Veterans with HIV also have increased rates of hepatocellular carcinoma (HCC) and Hodgkin lymphoma. While early studies did not find HIV to be an independent risk factor for HCC, a 2015 analysis found that veterans with HIV had a more than four-fold increased risk, with the greatest increase in risk seen in veterans who did not have cirrhosis. As with other veterans and the general population, chronic infection with the hepatitis C virus, alcohol use, chronic hepatitis B infection, and non-alcoholic fatty liver disease, increase HCC risk in veterans with HIV.
The VA’s aggressive treatment of hepatitis C infections may have favorable affected the risk of HCC among veterans with HIV.
“Treatment of hepatitis C is likely to decrease the burden of liver fibrosis among people with HIV (and people without HIV) and therefore decrease the risk of liver cancer. As far as I know we do not have discrete evidence of this yet, but it is likely,” Sigel suggested.
The risk for Hodgkin lymphoma among veterans with HIV increased directly with increases in HIV RNA copy-years. Lower CD4 counts also raised the risk, while long-term ART proved protective.
Greater understanding of the differences in cancer risk for veterans with HIV could improve their care and potentially further increase life expectancy in this population.
“Cancer is an important clinical issue in people with HIV. Screening and treatment of cancer may have unique considerations in this population, and certain cancers still appear to have different risk and outcomes in this group,” Sigel said. “Awareness of the higher risk of certain cancers such as anal cancer, lung cancer and lymphoma is important for clinicians caring for patients with HIV.”
- Sigel K, Park L, Justice A. HIV and cancer in the Veterans Health Administration System. Semin Oncol. 2019;46(4-5):334-340. doi:10.1053/j.seminoncol.2019.09.007
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