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Illnesses in the age of anti-HIV treatment – cancers
Anti-HIV treatments have brought longer and healthier lives for many people with HIV. Indeed, side-effects of treatment are the most likely cause of ill-health in HIV-positive people now, and in many cases these either lessen with time or can be controlled.
However, around 500 people a year in the UK develop an AIDS-defining illness, and around 400 people die every year because of HIV-related causes. Although illnesses such as PCP and TB still cause illness and even death in people with HIV, it seems that cancers and coinfection with hepatitis B and/or hepatitis C are becoming more common as causes of illness and death in people with HIV.
Kaposi’s sarcoma and non-Hodgkin’s lymphoma have become rarer since the introduction of effective anti-HIV treatment, but still 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 treatments 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 anti-HIV treatment became available. There is no evidence that anti-HIV drugs cause these cancers. The increased rates of some cancers seen in people with HIV since the introduction of HIV treatment have come about because people are living longer, and not dying of other illnesses.
Anal cancer
Anal cancer is emerging as a health concern, particularly for HIV-positive gay men. Human papilloma virus (HPV), the cause of genital and anal warts, is the underlying cause of anal cancer, and anti-HIV drugs are not effective against HPV. There has been a very slight increase in the amount of anal cancer seen in people with HIV since the introduction of anti-HIV treatments. Doctors think that this could be because HIV-positive people are living longer.
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. It takes a long time for AIN to progress to anal cancer. In some cases, AIN may be removed surgically.
Anal cancer is treated aggressively, with a combination of chemotherapy and radiotherapy. Sometimes, surgery is also needed, and the overall cure rate is about 60%.
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 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.
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 study, all the HIV-positive people who developed lung cancer were smokers.
Testicular cancer
There’s some evidence to suggest that testicular cancer is more common in HIV-positive men. The reason for this isn’t known. If you notice a lump in your testicles you should see a doctor as soon as possible. Treatment works just as well in HIV-positive men as in HIV-negative men. The sooner treatment is provided the better.
Cervical cancer
Since the mid-1990s, cervical cancer has been an AIDS-defining condition. Doctors have noticed an increase in the incidence of cervical cancer since effective HIV treatment became available. It’s important for HIV-positive women to have regular PAP smears.
Liver cancer
For information on liver cancer, see the section on Illnesses in the age of anti-HIV treatment - hepatitis.