FACT SHEETS

HIV and Risk

Do people infected with human include of the anus, • Kaposi -associated herpes- immunodeficiency (HIV) have an liver, oral cavity/, and lung, and virus (KSHV), also known as human increased risk of cancer? Hodgkin .3,4 herpesvirus 8 (HHV-8), which causes Yes. People infected with HIV have People infected with HIV are 19 times Kaposi sarcoma and some subtypes of a substantially higher risk of some more likely to be diagnosed with anal lymphoma types of cancer compared with unin- cancer, 3 times as likely to be diagnosed • Epstein-Barr virus (EBV), which fected people of the same age.1 The with , 2 times as likely to causes some subtypes of non-Hodgkin general term for these cancers is be diagnosed with lung cancer, about and “HIV-associated cancers.” Three of 2 times as likely to be diagnosed with • Human papillomaviruses (HPV), these cancers are known as “acquired oral cavity/pharynx cancer, and about 8 high-risk types of which cause cer- immunodeficiency syndrome (AIDs)- times more likely to be diagnosed with vical cancer, most anal cancers, and defining cancers” or “AIDS-defining Hodgkin lymphoma compared with the oropharyngeal, penile, vaginal, and malignancies”: Kaposi sarcoma, aggres- general population.2 sive B-cell non-Hodgkin lymphoma, In addition to being linked to an • virus (HBV) and hepa- and . A diagnosis of any increased risk of cancer, HIV infection titis C virus (HCV), which both cause of these cancers in someone infected is associated with an increased risk of liver cancer with HIV confirms a diagnosis of dying from cancer. HIV-infected people HIV-infected persons are more likely AIDS. with a range of cancer types are more to be infected with these than Compared with the general popu- likely to die of their cancer than HIV- people in the general population.10–13 lation, people infected with HIV are uninfected people with these cancers.5,6 In addition, the prevalence of some currently about 500 times more likely traditional risk factors for cancer, to be diagnosed with Kaposi sarcoma, Why might people infected with HIV especially (a known cause 12 times more likely to be diagnosed have a higher risk of some types of of lung and other cancers) and heavy with non-Hodgkin lymphoma, and, cancer? alcohol use (which can increase the among women, 3 times more likely Infection with HIV weakens the risk of liver cancer), is higher among to be diagnosed with cervical cancer.2 and reduces the body’s people infected with HIV.12,14 Also, In addition, people infected with HIV ability to fight viral that may because people infected with HIV are at higher risk of several other types lead to cancer.2,7,8 The viruses that are have compromised immune systems, of cancer (collectively called “non– most likely to cause cancer in people both and inflam- AIDS-defining cancers”).1,2 These other with HIV are9: mation may have direct or indirect ▶ FACT SHEETS

roles in the development of some can- cancers, and in fact there has been an is an option for them.9,16–19 Some drugs cers that are elevated in people infected increase in non–AIDS-defining cancers. may be used for both HBV-suppressing with HIV. 2,9 For example, the incidence of liver and therapy and cART.16 The poorer cancer survival of HIV- anal cancer may be increasing among Because HIV-infected women infected people may result, at least in HIV-infected individuals.2,15 have a higher risk of cervical cancer, part, from the weakened immune sys- An important factor contributing to the it is important that they be screened tem in such individuals. The increased increase in non–AIDS-defining cancers regularly for this disease. In addition, risk of death could also result from is that as cART has reduced the number the Centers for Disease Control and the cancer being more advanced at of deaths from AIDS, the HIV-infected Prevention (CDC) recommends vac- diagnosis, delays in cancer treatment, population has grown in size and become cination against human papillomavirus or poorer access to appropriate cancer older. The fastest growing proportion of (HPV) for women and men with HIV treatment. HIV-infected individuals is the over-40 infection up to age 26 years. Cervical age group. These individuals are now cancer guidelines that incor- Has the introduction of antiretroviral developing cancers common in older porate results of a and an HPV therapy changed the cancer risk of age and also have an increased cumula- DNA test are evolving, and women people infected with HIV? tive risk of developing HIV-associated should discuss screening options with The introduction of highly active cancers. their healthcare provider.20 antiretroviral therapy (HAART), Some researchers recommend anal also called combination antiretroviral What can people infected with HIV do Pap test screening to detect and treat therapy (cART), starting in the mid- to reduce their risk of cancer or to find early lesions before they progress to 1990s greatly reduced the incidence cancer early? anal cancer.21 However, it is not clear of certain cancers in HIV-infected Taking cART as indicated based on if this type of screening benefits all patients, especially Kaposi sarcoma and current HIV treatment guidelines HIV-infected people or if treating such non-Hodgkin lymphoma.2 The likely lowers the risk of Kaposi sarcoma and lesions prevents anal cancer. These explanation for this reduced incidence non-Hodgkin lymphoma and increases questions are being addressed in an is that cART lowers the amount of overall survival. NCI-funded trial called the Anal HIV circulating in the blood, thereby The risk of lung, oral, and other Cancer/HSIL Outcomes Research allowing partial restoration of immune cancers can be reduced by quitting (ANCHOR) Study. This study is system function to fight the viruses that smoking. Because HIV-infected people currently enrolling men and women cause many of these cancers. have a higher risk of lung cancer, it is with HIV to undergo anal Pap test- Although the risk of these AIDS- especially important that they do not ing and then be randomly assigned to defining cancers among people infected smoke. receive either treatment or observation with HIV is lower than in the past, it is The higher incidence of liver cancer (no treatment). The goal is to deter- still much higher than among people in among HIV-infected people appears mine whether treatment of anal lesions the general population.15 This persistently to be related to more frequent infec- prevents anal cancer in HIV-infected high risk may reflect the fact that cART tion with hepatitis virus (particularly people with anal lesions. does not completely restore immune HCV in the United States) than among KSHV is secreted in saliva, and trans- system functioning. Also, many people HIV-uninfected people.12,16 Therefore, mission of this virus may occur through infected with HIV are not aware they are HIV-infected individuals should know deep kissing, through the use of saliva as infected, have had difficulty in accessing their hepatitis status. a lubricant in sex, or through oral–anal medical care, or for other reasons are not In addition, if HIV-infected people sex. Reducing contact through these receiving adequate antiretroviral therapy. currently have , they routes may reduce the chance of being The introduction of cART has not should discuss with their health care infected with KSHV. reduced the incidence of all HIV-related provider whether antiviral treatment FACT SHEETS

Selected References 8. Dubrow R, Silverberg MJ, Park LS, Crothers immunodeficiency virus and viral hepatitis in 1. Grulich AE, van Leeuwen MT, Falster MO, K, Justice AC. HIV infection, aging, and the HAART era. World Journal of Gastroenterology Vajdic CM. Incidence of cancers in people with immune function: implications for cancer risk 2008; 14(11):1657–1663. HIV/AIDS compared with immunosuppressed and prevention. Current Opinion in 2012; 17. McGinnis KA, Fultz SL, Skanderson M, et transplant recipients: a meta-analysis. Lancet 2007; 24(5):506-16. al. and non-Hodgkin’s 370(9581):59–67. 9. Goncalves PH, Montezuma-Rusca JM, lymphoma: the roles of HIV, infection, 2. Hernández-Ramírez RU, Shiels MS, Dubrow Yarchoan R, Uldrick TS. Cancer prevention in and alcohol abuse. Journal of Clinical Oncology 2006; R, Engels EA. Cancer risk in HIV-infected people HIV-infected populations. Semininars in Oncology 24(31):5005–5009. in the USA from 1996 to 2012: a population-based, 2016; 43(1):173-188. 18. Naggie S, Cooper C, Saag M, et al. Ledipasvir registry-linkage study. Lancet HIV 2017 Aug 10. 10. Powles T, Macdonald D, Nelson M, Stebbing J. and sofosbuvir for HCV in patients coinfected pii: S2352-3018(17)30125-X. Hepatocellular cancer in HIV-infected individuals: with HIV-1. New England Journal of Medicine 2015; 3. Wang CC, Silverberg MJ, Abrams DI. Non- tomorrow’s problem? Expert Review of Anticancer 373(8):705-713. AIDS-defining malignancies in the HIV-infected Therapy 2006; 6(11):1553–1558. [PubMed Abstract] 19. Wyles DL, Ruane PJ, Sulkowski MS, et al. population. Current Infectious Disease Reports 2014; 11. Angeletti PC, Zhang L, Wood C. The viral eti- Daclatasvir plus sofosbuvir for HCV in patients 16(6):406. ology of AIDS-associated malignancies. Advances coinfected with HIV-1. New England Journal of 4. Silverberg MJ, Lau B, Achenbach CJ, et al. in Pharmacology 2008; 56:509–557. Medicine 2015; 373(8):714-725. Cumulative incidence of cancer among persons 12. Silverberg MJ, Abrams DI. AIDS-defining 20. Robbins HA, Strickler HD, Massad LS, et al. with HIV in North America: A cohort study. and non-AIDS-defining malignancies: cancer Cervical cancer screening intervals and manage- Annals of Internal Medicine 2015; 163(7):507-518. occurrence in the antiretroviral therapy era. Current ment for women living with HIV: a risk bench- 5. Coghill AE, Shiels MS, Suneja G, Engels EA. Opinion in Oncology 2007; 19(5):446–451. marking approach. AIDS 2017; 31(7):1035-1044. Elevated cancer-specific mortality among HIV- 13. Grogg KL, Miller RF, Dogan A. HIV infection 21. Goldie SJ, Kuntz KM, Weinstein MC, et al. infected patients in the United States. Journal of and lymphoma. Journal of Clinical Pathology 2007; The clinical effectiveness and cost-effectiveness of Clinical Oncology 2015; 33(21):2376-2383. 60(12):1365–1372. [PubMed Abstract] screening for anal squamous intraepithelial lesions 6. Coghill AE, Pfeiffer RM, Shiels MS, Engels 14. Park LS, Hernández-Ramírez RU, Silverberg in homosexual and bisexual HIV-positive men. EA. Excess mortality among HIV-infected indi- MJ, Crothers K, Dubrow R. Prevalence of non- Journal of the American Medical Association 1999; viduals with cancer in the United States. Cancer HIV cancer risk factors in persons living with HIV/ 281(19):1822–1829. , Biomarkers & Prevention 2017 Jun 15. AIDS: a meta-analysis. AIDS 2016; 30(2):273-291. For full-length article and references, please see doi: 10.1158/1055-9965.EPI-16-0964. 15. Robbins HA, Shiels MS, Pfeiffer RM, Engels the online version of this article. 7. Shiels MS, Cole SR, Kirk GD, Poole C. A EA. Epidemiologic contributions to recent cancer meta-analysis of the incidence of non-AIDS trends among HIV-infected people in the United Source: National Cancer Insititute. ■ cancers in HIV-infected individuals. Journal States. AIDS 2014; 28(6):881–890. of Acquired Immune Deficiency Syndromes 2009; 16. Macdonald DC, Nelson M, Bower M, 52(5):611-22. Powles T. Hepatocellular carcinoma, human

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