CANCER IN HIV (RETROVIRAL DISEASE) POSITIVE INDIVIDUALS
People with HIV infection or AIDS can get cancer, just like anyone else. They are actually more likely to get some types of cancer than people who are not infected. In fact, some types of cancer occur so often in people with AIDS that they are considered AIDS-defining conditions – that is, their presence in a person infected with HIV is a clear sign that full-blown AIDS has developed.
Some other cancers are also more common in people with HIV or AIDS than people who are not infected, but the reasons for the increased risk aren’t clear. It may be that some of these cancers are able to develop and grow more quickly because of a weakened immune system brought on by the infection itself. In other cases it may be because people with HIV infection or AIDS are more likely to have certain other risk factors for cancer, such as being smokers.
As people with HIV infection have been living longer, they are also developing other types of cancer that are more common in older people. The use of anti-HIV drugs has also led to better cancer survival rates for people with HIV, as many people are now able to get full doses of chemotherapy and other standard cancer treatments, which may not have been possible in the past.
How is cancer treated in people with HIV or AIDS?
Before effective anti-HIV drugs became available, the outlook for people with HIV or AIDS who developed cancer usually was not nearly as good as it was for people with similar cancers who were not infected. People with HIV were often already sick, or at least had a weakened immune system, before they even started cancer treatment.
A weak immune system itself may allow some cancers to grow and spread faster than they normally would. Another problem is that cancer treatments such as chemotherapy and radiation therapy can also weaken the immune system. People who already have a weak immune system might not be able to get the full course of cancer treatment without risking severe side effects such as possible life-threatening infections.
Today, people with HIV and cancer are usually treated much like people without HIV infection. The cancer treatment itself is based on the type and stage (extent) of the cancer. Treatment typically includes anti-HIV drugs along with standard cancer treatments. At the same time, any other needed treatments for HIV (such as antibiotics to help prevent infections) are used.
Some aspects of treatment may need to be adjusted in people with HIV. For example, cancer treatment may sometimes need to be changed because of other conditions in people with HIV. Some anti-HIV drugs can also interact with many other drugs in the body, which can complicate cancer treatment. Anti-HIV drugs can also have their own side effects, some of which can be the same as those caused by chemotherapy.
Treatment of both HIV and cancer can be complex, so it is very important that both treatments are coordinated by doctors who have experience with these diseases.
Anti-HIV drugs allow many people with cancer to get full doses of chemotherapy and other standard cancer treatments. This has led to better survival with anti-cancer treatment. But even with standard treatments, people with HIV may still have slightly lower success rates with certain types of cancer, depending on the state of their immune systems and other factors. Because of this, doctors are studying various cancer treatments and their outcomes in people HIV infection.
Treatment of AIDS-defining cancers
Treatment with anti-HIV drugs is an important part of treating cancers that define a person with HIV as having AIDS.
Kaposi sarcoma: In general, people with HIV who are diagnosed with Kaposi sarcoma (KS) are started on anti-HIV drugs if they are not already on them. For some people, this may be the only treatment they need. KS lesions, which are caused by a virus, often shrink as the immune system gets stronger.
Other people may need treatment directed at the cancer itself. If there are only a few skin or mouth lesions, local treatments may be used, such as radiation directed at the lesions. Chemotherapy may be needed if there are many lesions, if they are inside the body, or if they are causing bothersome symptoms.
Non-Hodgkin lymphoma: There are many types of non-Hodgkin lymphoma (NHL), but those linked with HIV and AIDS tend to be fast-growing types that require intensive chemotherapy treatment. The best treatment for AIDS-related NHL is much like the treatment of NHL in those without HIV infection.
The major problem in the past was that patients with HIV tended to have low blood cell counts to begin with, which made it hard to treat them with full courses of chemotherapy. This problem has been relieved somewhat by the use of highly active anti-retroviral therapy (HAART) and by the use of drugs to help the patient’s body make new blood cells. Still, doctors give chemotherapy cautiously and monitor blood counts closely during treatment.
The outcome for patients with AIDS-related NHL depends on the type of lymphoma and on the person’s immune function, as well as other factors. People with advanced NHL, a low CD4 (helper T-cell) count, and/or who don’t get anti-HIV drugs don’t usually do as well as people without these factors.
Cervical cancer: HIV-infected women with invasive cervical cancer and good immune function tend to do well with surgery and the same treatments that women without HIV get. Those who have more advanced disease tend to respond poorly to radiation therapy alone. Chemotherapy can be used in women with advanced or recurrent disease. Women with HIV need to be watched closely after treatment to be sure the cancer doesn’t come back.
During cancer treatment, the woman’s immune status must be watched and her HIV infection treated. Anti-HIV drugs are usually given to improve the treatment outcome for HIV-infected women with cervical cancer, no matter what her CD4 (helper T-cell) counts are.
Women with cervical cancer tend to fare better if they do not have AIDS, and those with high CD4 counts tend to have better outcomes.