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Today, on World Cancer Day, we shine a spotlight on the intersection of cancer and HIV. Cancer remains a significant health challenge for people living with HIV, with unique risks and barriers that highlight the urgent need for integrated care and prevention strategies.
When discussing cancer in the context of HIV, it is helpful to first discuss the term AIDS-defining illnesses. These conditions occur when the immune system of an individual living with HIV becomes severely compromised, typically indicated by a CD4 cell count below 200 cells/mm³ or the presence of certain opportunistic infections or cancers. AIDS-defining illnesses are pivotal in diagnosing AIDS, the most advanced stage of HIV infection. What does this mean in practice? When someone living with HIV develops one or more of these conditions, their HIV diagnosis progresses to AIDS, regardless of their CD4 count. These illnesses are significant because they indicate that the immune system is no longer robust enough to protect the body from infections or certain cancers.
Cancer is a critical health concern in the context of HIV, as people living with HIV (PLHIV) are at a higher risk of developing certain cancers compared to the general population. But having HIV doesn’t make you more susceptible to all cancers. Rates of other types of cancer are the same (or lower) in people living with HIV than in the general population. So, while prostate and breast cancer do affect large numbers of people with HIV, this is simply because they are very common cancers across the population. So called AIDS-defining cancers, such as Kaposi’s Sarcoma and Invasive Cervical Cancer, underscore the immune system’s vulnerability in the absence of effective treatment.
Global funding has been instrumental in making antiretroviral therapy (ART) widely available, leading to a significant decrease in the progression of HIV to AIDS and the development of associated cancers in many parts of the world. However, challenges remain, particularly in Africa, where HIV prevalence is especially high among women. Research indicates that more than half of women diagnosed with cervical cancer in southern Africa are living with HIV. One study1 estimated that 86% of cervical cancer cases in this region are attributable to HIV infection in women under the age of 35. It is, therefore, evident that cancer continues to pose major public health challenges for PLHIV in this region who frequently have limited access to ART and comprehensive cancer care.
Fortunately, the widespread use of ART has significantly reduced the incidence of AIDS-defining cancers by improving immune function. However, as PLHIV now live longer due to effective treatment, there has been a rise in non-AIDS-defining cancers. A recent study2 using South African health data analysing 5.2 million individuals, found that breast cancer emerged as the third most common cancer among PLHIV, following cervical cancer and Kaposi’s sarcoma. These include cancers like anal cancer and liver cancer, often linked to chronic inflammation (persistent immune activation) and co-infections with cancer-causing viruses, such as Hepatitis B (HBV) or Human Papillomavirus (HPV). This shift necessitates enhanced cancer screening and treatment strategies tailored for the aging population of PLHIV.
Addressing cancer in the context of HIV requires a proactive approach. Regular cancer screening—such as cervical or anal cytology for detecting cervical or anal cancer—is vital for early detection and improved outcomes. Additionally, vaccination against HBV and HPV is critical, as these viruses are significant contributors to cancer risk in PLHIV. Comprehensive care through multidisciplinary models is key. Integrating HIV management with cancer prevention, early diagnosis, and treatment ensures that PLHIV receive holistic care tailored to their unique health needs. Making healthy lifestyle choices can lower the risk of cancer, especially for people living with HIV. Quitting smoking, limiting alcohol, eating a balanced diet, maintaining a healthy weight, and staying active all help reduce cancer risk. Protecting your skin from the sun and avoiding tanning beds can prevent skin cancer. By addressing cancer as a critical comorbidity of HIV, we can further improve the quality of life and survival outcomes for people living with HIV. As we move forward, continued efforts in prevention, education, and equitable access to healthcare will remain essential in overcoming these challenges.
1Ibrahim Khalil A, Mpunga T, Wei F, et al. Age-specific burden of cervical cancer associated with HIV: a global analysis with a focus on sub-Saharan Africa. Int J Cancer. 2022; 150: 761-772. 2Ruffieux Y, Muchengeti M, Olago V, et al. Age and cancer incidence in 5.2 million people with human immunodeficiency virus (HIV): the south African HIV cancer match study. Clin Infect Dis. 2023; 76: 1440-1448.
