HIV and AIDS Related Cancer
Introduction[edit | edit source]
The Human Immunodeficiency Virus (HIV) is a virus that attacks the body's immune system. Without treatment, HIV will progress into Acquired Immune-Deficiency Syndrome (AIDS), which is characterised by opportunistic infections and tumours that are usually fatal if untreated. There are 4 stages of through which the condition progresses, covering: infection; asymptomatic; symtomatic and; the progression of HIV to AIDS. Please visit our Physiopedia page to learn more about the stages of HIV infection. AIDS is defined by the development of certain cancers, infections or other severe long-term clinical manifestations.
People living with HIV or AIDS are more likely to get certain types of cancers. These cancers can be classified into either: AIDS defining cancers, where developing certain cancers signifies that the HIV infection has progressed to AIDS; or Non-AIDS defining cancers.
Aetiology[edit | edit source]
Most HIV-associated cancers are caused by oncoviruses such as KSHV, Epstein–Barr virus (EBV), high-risk human papillomavirus (HPV), hepatitis B virus (HBV), hepatitis C virus (HCV), and Merkel-cell polyomavirus. As the HIV infection compromises the body's immune system, infected individuals are at greater risk of opportunistic viral infections, and as the immunologic control of these viruses and virus-infected cells is impaired, which permit the development of cancer.
It has been questioned whether the increased rate of cancer in people with HIV/AIDS was due to lifestyle factors such as risky sexual behaviours, needle sharing, smoking and an ageing population where the risk factor for common incidental cancers increase. However, research has found that other immune-deficient populations, such as transplant recipients, show a similar pattern of increased risk of certain cancers; this indicates that the immune deficiency, rather than other life-style related factors are responsible for the increased risk.
Incidence[edit | edit source]
Overall the rate of AIDS-defining cancers decreased in the mid-1990s as a result of the success of anti-retroviral therapy. The rates of AIDS-defining cancers has remained relatively steady for the past two decades, but the rates of non–AIDS-defining cancers has increased and accounts for an increasing proportion of cancer-related morbidity and mortality in this population.
Having HIV or AIDS creates a greater risk for developing AIDS-related cancers. People with HIV or AIDS are: 500 times more likely to be diagnosed with Kaposi sarcoma; 12 times more likely to be diagnosed with non-Hodgkin lymphoma and; 3 times more likely to be diagnosed with cervical cancer when compared to those without HIV or AIDS. People with HIV infection also have a higher risk of dying from cancer than people with the same cancers but without HIV infection. A study in France has shown that cancer is the leading cause of death in HIV-infected persons in highly developed countries.
As people with HIV Infection are living longer, due to the success of antiretroviral therapies, a large proportion of HIV-infections people are at an age where the risk of cancer is increased. As a result a wide variety of cancers now develop in patients with HIV infection in association with a range of stages of the condition.
Types of HIV and Aids-Related Cancer[edit | edit source]
AIDS-defining cancers[edit | edit source]
Kaposi’s sarcoma, aggressive B-cell lymphomas, and invasive cervical cancer are all considered to be AIDS-defining cancers when they develop in patients with HIV infection, as this signifies the HIV Infection has progressed to AIDS.
- Kaposi's Sarcoma
Kaposi's sarcoma is rare in people without HIV or AIDS. It causes purple or brown spots on your skin or around your mouth, and can affect internal organs.
- Aggressive B-cell non-Hodgkin lymphoma (NHL)
Common symptoms are fever, unexplained weight loss, night sweats, swollen lymph nodes, and a feeling of fullness in the chest. Lymphoma can also occur in the brain. which causes memory loss, confusion, seizures, and fatigue.
This cancer causes abnormal vaginal bleeding or discharge, pain during sex, and longer or heavier periods.
Non-AIDS-defining cancers[edit | edit source]
This larger group of cancers are known to be associated with HIV infection, in that there is a larger incidence in people with an HIV infection.
- Head and neck cancer
Prevention[edit | edit source]
Most HIV and AIDS related cancers are caused by oncogenic viruses and are potentially preventable. The most important methods of prevention are early diagnosis, maintaining treatment of HIV with anti-retroviral therapy, and adopting a healthy lifestyle.
Resources[edit | edit source]
The following physiopedia pages give further information on the role of physiotherapy within cancer care.
- Prehabilitation in Cancer Care
- Clinical Guidelines: Oncology
- Cancer Pain
- Physiotherapy and Cancer Treatment
References[edit | edit source]
- World Health Organisation. HIV/AIDS [online]. 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids. [Accessed 17 Jan 2022]
- Yarchoan R, Uldrick TS. HIV-Associated Cancers and Related Diseases. N Engl J Med. 2018 Mar 15;378(11):1029-1041[Accessed 17 Jan 2022]
- Frisch M, Biggar RJ, Engels EA, Goedert JJ. Association of cancer with AIDS-related immunosuppression in adults. Journal of the American Medical Association. 2001; 285: 1736–45. [Accessed 17 Jan 2022]
- Grulich A, van Leeuwen M, Falster M, Vajdic C. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007; 370: 59–67. [Accessed 17 Jan 2022]
- Cancer.Net. HIV/AIDS-Related Cancer: Statistics [online]. 2021. Available from: https://www.cancer.net/cancer-types/hivaids-related-cancer/statistics [Accessed 17 Jan 2022]
- Morlat P, Roussillon C, Henard S, et al. Causes of death among HIV-infected patients in France in 2010 (national survey): trends since 2000. AIDS. 2014; 28: 1181–91. [Accessed 17 Jan 2022]