The Bay Area Reporter - November 9, 2000
Matt Sharp, Survive AIDS Writers Pool

Opportunistic infections, causing sickness and death in AIDS due to a weakened immune system, are down 80-90 percent in the era of HAART (highly active antiviral therapy). The new drugs have shown an effect in slowing AIDS-related cancers as well. Kaposi's sarcoma, an opportunistic skin cancer, has actually decreased since the advent of antiviral therapy. However, deaths due to non-Hodgkin's lymphoma have not changed much due to HAART. One recent study reported in the journal Blood appears to show that in a cohort in London, AIDS-related non-Hodgkin's lymphoma cases are staying constant when you compare rates before and after the advent of antivirals. The researchers found that developing lymphoma depends on how low CD4 counts have gotten and if the person ever started antivirals. Rates of the opportunistic cancers may in fact depend on a better functioning immune system and control and maintenance of HIV.

Cervical cancer is the third AIDS-defining cancer that is seen in women. Rates of deaths compiled by the Centers of Disease Control and Prevention show that cervical cancer was at 5.6 percent among all cancers in HIV-positive women. Cervical and anal cancer rates are high, however, not because of immune deficiency and AIDS, but from the sexually acquired human papillomavirus. This information may make people think twice about using precautions in sex.

But rates of non-AIDS-defining cancers that are not reportable AIDS conditions are apparently on the rise according several reports. Steve Deeks, noted clinician and AIDS researcher from San Francisco General Hospital, has compiled information from a cohort of AIDS patients from the hospital that shows cancer is the leading cause of death out of 64 deaths in the past three years. Also, the San Francisco Department of Public Health is reporting that in 1995-1997, non-defining AIDS cancers are 2.3 percent of total AIDS deaths in San Francisco, almost doubled from the previous reporting period in 1991-1994. Other studies are also showing an increase in cancers that may be related to other risk factors and the fact that people with HIV are simply living longer. Nevertheless, data has been hard to come by because of the way deaths are reported in people with HIV. Few have been alerted to the unusual trends in non-AIDS defining malignancies because of inefficient surveillance, lack of interest and support, and possibly denial.

Researchers at the University of Texas compared non-AIDS malignancies in a cohort of people with HIV to the general population and found an increase in cancers similar to that in transplant patients. Another review of data from the University of Texas Southwestern Medical Center in Dallas shows that the spectrum of non-AIDS defining malignancies is expanding. The team stressed the importance of better tracking of the biology and numbers of these non-AIDS cancers in HIV and compare them to the general population. The CDC reported that cancers such as rectal, testicular, oral, leukemia, laryngeal, uterine, and connective tissue cancer, reported in a period between 1990 and 1995, really before the advent of antivirals, were more common in people with HIV than in the general population. Multiple myeloma, (a type of bone cancer) has seen a rise in HIV and recently was found in the laboratory to be a possible link to HHV-8, the virus that causes Kaposi's sarcoma. Studies in people have not confirmed this laboratory finding.

It is not uncommon to hear about anal cancer in men and women today. Sadly, two respected East Coast AIDS treatment activists recently succumbed to complications related to anal cancer. According to Joel Palefsky, researcher at UCSF, the incidence of invasive anal cancer has been increasing over the past few years among HIV-positive men and today it is twice as high as in HIV-negative men. It appears that the longer a person on HAART therapy survives with HIV, the higher their risk of developing anal cancer. Hopefully physicians and patients will be more assertive with effective screening and monitoring for anal changes as patients are living longer.

Liver cancer has become a problem in people who are co-infected with hepatitis C. Unfortunately, data for co-infection and rates of liver cancer have not been gathered. Brian Klein, activist from HAAC (Hepatitis and AIDS Activist Coalition) stated, "Most studies suggest that 1 percent to 3 percent of those singly infected with hepatitis C go from progression of liver disease to cirrhosis to liver cancer. Untreated, co-infection leads to greater liver disease progression than singly infected folks; therefore if co-infecteds are untreated there is a potential for increased risk of hepatocellular [liver] carcinoma." Klein stresses the need for more natural history studies in people that are co-infected.

It is devastating that surviving AIDS may increase chances of non-HIV-related cancers. However, Deeks and Palefsky have said that as in people without HIV, standard prevention, early detection, screening and monitoring, and lifestyle changes could help in reducing risk. It can be difficult to change human behavior such as stopping smoking, eating high fiber diets, having safer sex, and using clean needles. And there is little we can do about the possible risks of long term antiviral therapy and impaired immune systems which could very be the cause of higher rates of non-HIV cancers.

So the questions remain. Does living longer with an impaired immune system and/or lowered HIV viral load mean that more cancers will spread? Do the new powerful AIDS drugs cause cancer in the long term? What cancers can we expect to see down the line? Is the chronic management of HIV in jeopardy because of another life threatening disease?

Conflicting data and poor reporting of the cancers do not give us a complete picture of what is going on. More studies and better surveillance mechanisms need to be the focus of researchers, epidemiologists and activists since people with HIV are living longer, healthier lives.

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Always watch for outdated information. This article first appeared in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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