In 1981, a handful of young men in New York City were diagnosed with, Kaposi sarcoma; however, the disease features and presentation in this group were unlike the form typically recognized in North America and Europe.1 This change actually heralded the start of the HIV epidemic, even though the virus was not identified until 1984. In the beginning of the HIV epidemic, the AIDS-defining malignancies included cervical cancer, Kaposi sarcoma, Burkitt lymphoma, immunoblastic lymphoma and primary brain lymphoma.2 It was discovered that all of these cancer types have a viral etiology (human papillomavirus [HPV], human herpesvirus 8 [HHV-8], and Epstein-Barr virus [EBV]).3
Now, more than 30 years after the epidemic began, studies are showing that cancer is a much greater concern for HIV-infected individuals. Unfortunately, it is uncertain whether immunosuppression, persistent HIV replication, or traditional risk factors for cancer such as tobacco and alcohol use are part of the problem.
At the start of the HIV epidemic, 1 in 3 individuals with HIV had Kaposi sarcoma. However, within 1 year of the widespread availability of highly active antiretroviral therapy (HAART), the incidence of Kaposi sarcoma dropped 10-fold, according to physician-researcher Corey Casper, MD, MPH, an associate professor of Allergy and Infectious Diseases at the University of Washington, and with the Fred Hutchinson Cancer Research Center, Seattle, Washington.
“HIV in and of itself is probably carcinogenic. Each year that you have HIV in your blood and the virus is suppressed, your risk for cancer goes up 20[%] to 30% a year, even in the absence of high levels of uncontrolled HIV replication. Pro-inflammatory and pro-carcinogenic cytokines are being made,” Dr. Casper said in an interview with ChemotherapyAdvisor.com. “There are nearly 100,000 HIV-positive individuals in the United States who have been diagnosed with cancer, and the numbers just keep going up.”
What is happening in the community?
Dr. Prelutsky has been caring for HIV patients for 28 years. His private practice has more than 2,000 HIV infected patients. Approximately 250 of the HIV-positive patients in his practice have had HIV for more than 20 years. He said his practice mimics national trends. He has also found that many cancer types are more common in long-term survivors of HIV.
Dr. Prelutsky explained liver cancers may be more common in HIV-infected patients because many more are coinfected with hepatitis B and hepatitis C than non-HIV infected patients. As an example, Dr. Prelutsky described that a very high percentage of his HIV-positive patients are smokers and, despite continued cessation efforts, smoking continues to be a problem. Smoking contributes to the cancer burden and, particularly, lung cancer risk in these patients. Dr. Prelutsky noted that improved primary and secondary lung cancer prevention, in addition to a stronger, collaborative effort between the oncologist and HIV-specialist, is warranted in this patient population.