Non-HIV-related illnesses – cancers

Kaposi’s sarcoma and non-Hodgkin’s lymphoma have become rarer since the introduction of effective HIV treatment, but still occasionally cause illness and death in people with HIV. Often, these people have very weak immune systems, but there have been cases of these cancers developing in people who are taking HIV treatment and have good CD4 cell counts.

Other cancers that are not regarded as AIDS-defining conditions appear to have become more common in HIV-positive people since effective HIV treatment became available. Some of these are linked to other infections, particularly some strains of the virus that causes genital and anal warts, the human papillomavirus (HPV).

There is no evidence at all that anti-HIV drugs cause these cancers. The increased rates of some cancers seen in people with HIV since the introduction of HIV treatment may be due to infections other than HIV, other long-term health risks such as smoking or diet, or simply to the fact that people are living longer (the risk of developing cancer increases with age).

Anal cancer

Anal cancer is rare in the general population. It is still a rare cancer amongst people with HIV, but it is an emerging as a health concern, particularly for HIV-positive gay men. Some strains of the human papillomavirus (HPV), the virus that can also cause genital and anal warts, can be the underlying cause of anal cancer. There has been a very slight increase in the amount of anal cancer seen in people with HIV since the introduction of HIV treatments. Doctors think that this could be because HIV-positive people are living longer and HPV infection takes years, even decades, to cause cancer. Having a weakened immune system can also increase the risk of developing anal cancer.

Before cancer develops, pre-cancerous lesions, called AIN (anal intraepithelial neoplasia), form. These are graded AIN I, AIN II, and AIN III according to severity. AIN doesn't always lead to anal cancer – in most cases it goes away by itself, and even if disease does progress, it tends to do so at a slow rate.

Some HIV clinics are looking at the value of screening people with HPV in their anus or rectum for AIN. This involves using a test very similar to the cervical screening (Pap smear) used to detect pre-cancerous cervical cells in women. Although these tests aren’t 100% accurate, the earlier AIN is detected, the greater the chance of effective treatment. DNA testing is also showing promise as a way of detecting potentially cancer-causing strains of HPV.

Should anal cancer develop, it is usually treated with a combination of chemotherapy and radiotherapy. Sometimes, surgery is needed to remove small tumours. The overall cure rate for anal cancer is between 60 and 75%. Outcomes are better in cases that are diagnosed early.

Vaccines against the strains of HPV particularly associated with anal and cervical cancer have been developed. The vaccines work best if given before a person becomes sexually active and, at the moment, UK vaccine strategies at targeted at school-aged girls. But there’s emerging evidence that their use could also be beneficial for young gay men and for people with HIV. It is available privately, but this is an expensive option.

Head, oral and neck cancers

Cancers of the head and neck (which include cancers in the mouth, throat, and sinuses) are rare, but it seems that the risk of them is higher – although they are still very unusual – in people with HIV. This seems to be due to infection with cancer-associated strains of the human papillomavirus (HPV), which can be transmitted by oral sex.

It makes good sense to alert your doctor to any unusual symptoms in your mouth or throat such as pain, inflammation, a lump, warts or white patches, difficulty swallowing, changes to your voice or constant sore throat or earache on one side.  These can have causes other than pre-cancerous or cancerous cell changes. Your doctor will be able to investigate the cause so you receive the most appropriate treatment. 

Liver cancer

For information on liver cancer, see the section on Non-HIV-related illnesses - hepatitis.

Lung cancer

People with HIV seem to be at increased risk of developing lung cancer. It’s very rare, however, and the outcome is no worse in people with HIV than it is in those without HIV. In one large and important study, smoking was by far the most important risk factor.

Testicular cancer

Testicular cancer is more common in HIV-positive men, particularly a type called seminoma. The reason for this isn’t known. If you notice a swelling or lump in your testicles, you should see a doctor as soon as possible (these symptoms can also be caused by other things). Treatment works just as well in HIV-positive men as in HIV-negative men.

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.