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Cancers in people with HIV: who gets them, and which ones?
Keith Alcorn, 2012-03-12 00:00:00
A very low CD4 count in the past, and a history of smoking, are the most consistent risk factors to emerge from large studies of risks for developing non-AIDS-defining cancers, researchers reported at the 19th Conference on Retroviruses and Opportunistic Infections in Seattle this week.
In particular, studies found that cancers were concentrated in older people, those who had experienced very low CD4 cell counts before starting highly active antiretroviral therapy, and those who had very high viral loads before starting treatment – but risk factors differed according to the type of cancer, indicating the complex interactions between HIV disease, ageing and the era in which individuals diagnosed with cancer first began HIV therapy.
Fears that people with HIV might suffer a disproportionate burden of cancers as they age have been expressed as a result of epidemiological evidence from a number of large cohort studies indicating a higher rate of some types of cancers, particularly those with an infectious cause, in people living with HIV.
These cancers are known as non-AIDS-defining malignancies. They are not AIDS-defining illnesses and can occur even at high CD4 cell counts, just as in the rest of the population. They include organ cancers such as liver and lung cancer, tissue cancers such as skin cancers, oral and pharyngeal cancer, and anal cancer caused by HPV. (Invasive cervical cancer is an AIDS-defining cancer.)
A number of analyses of large patient populations were presented last week at the 19th Conference on Retroviruses and Opportunistic Infections in Seattle, providing reassurance regarding some aspects of cancer risk in people living with HIV, but also underlining the importance of vigilance for potential cancers in people with a past history of severe immunosuppression.
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