Dr. Ramya Ramaswami is an oncologist in the HIV and AIDS Malignancy Branch of the National Cancer Institute. She cares for people with HIV and cancer.

In 1981, several cases of a rare skin cancer called Kaposi sarcoma were reported in young gay men. This alerted the medical community to the existence of a new condition called acquired immunodeficiency syndrome (AIDS) and its underlying cause, human immunodeficiency virus (HIV). Over the next several years, non-Hodgkin lymphoma and cervical cancer were also seen among people with AIDS. These 3 conditions—Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer—were termed “AIDS-defining” cancers, meaning that when a person with HIV is diagnosed with 1 of these cancers, AIDS has likely developed. Other cancers, such as lung cancer or liver cancer, that can arise in individuals with HIV/AIDS are called “non-AIDS defining” cancers.

The link between HIV and cancer has been investigated extensively. HIV infection leads to a weakened immune system and a lower number, or count, of CD4+ T cells that help fight infection. This makes it more likely that people living with HIV will be infected with cancer-causing viruses, such as human papillomavirus and Kaposi sarcoma herpesvirus.  Treatment with combination antiretroviral treatment (cART), which means using more than 1 drug to fight HIV infection and maintain the immune system, leads to reduced risk of infections and HIV-associated cancers.

In the last 2 decades, cART has helped people with HIV live longer; however, there is an increasing risk for cancer as they age, similar to people without HIV. This means that people living with HIV must also be aware of their risk of developing other types of cancer.

Reducing your cancer risk

Cancer is one of the diseases most commonly found in people living with HIV in the United States and other developed countries. It’s also a leading cause of death in people living with HIV. Lung cancer, liver cancer, Hodgkin lymphoma, anal cancer, and head and neck cancers are some of the non-AIDS defining cancers that are more common in the HIV-positive population. These cancers are associated with risk factors such as smoking, chronic inflammation due to HIV, and the presence of other viruses, such Epstein-Barr virus, hepatitis B, or hepatitis C.

It is hard to eradicate all the viruses that cause cancer. However, there are things you can do to change many of these risk factors and lower your cancer risk.  

• Take your HIV medication. Maintaining a higher CD4+ T-cell count can reduce the risk of AIDS-defining cancers, such as Kaposi sarcoma and certain forms of lymphoma.

• Be knowledgeable about other viruses. A person with both a hepatitis virus and HIV has an increased risk of developing liver cancer. There are now antiviral drugs that can control hepatitis B along with HIV, and others that can cure hepatitis C.

• Stop smoking. Smoking causes many lung cancers and can increase the risk for other cancers, such as cervical cancer and head and neck cancer. It also contributes to emphysema, cardiovascular (heart) disease, and other illnesses. Lung cancer is the most common cause of cancer-related deaths in people living with HIV, so every effort should be made to stop smoking.

• Get screened. Women with HIV should have a Pap test every year to screen for cervical cancer. After 3 normal Pap tests, screening is done every 3 years for life. Yearly digital rectal examinations can help detect anal cancer at an early stage, too. There’s no standard screening program for anal cancer, but any anal symptoms, such as warts, pain, or bleeding, should be promptly investigated and treated. People with both hepatitis and HIV should have a liver ultrasound twice a year. People living with HIV should follow the same guidelines for colon and breast cancer screening as people without HIV.

Getting cancer treatment

If you have HIV and you are diagnosed with cancer, it’s important to find an oncologist experienced in managing your specific type of cancer and who has experience caring for people with HIV. In general, treatment for cancer in people living with HIV should be the same as those who are HIV-negative. For example, a Hodgkin lymphoma study showed that when patients, regardless of their HIV status, received the same chemotherapy treatment, the overall survival rate was the same, even though people living with HIV had an advanced stage of cancer.

The infectious disease team providing your HIV care and the cancer care team should work together to identify the right management plan for both conditions. The infectious disease team can provide advice on HIV medication to prevent any drug interactions with cancer treatment. Both teams can help you explore clinical trials.

Although many cancer clinical trials exclude people living with HIV due to concerns about the safety of cancer treatment and potential drug interactions with cART, this is starting to change. A number of groups in the oncology community now recommend that people with HIV be included in clinical trials unless there is a clear reason for them not to be. Ask your doctor what clinical trials are available for you and if you should get a second opinion.