- HIV treatment has extended life expectancies and reduced the risk of many cancers
- However, people with HIV still have a higher risk for some cancers than people without HIV
- As people with HIV live longer, risk also increases for cancers seen more among older people
When used as directed, HIV treatment (antiretroviral therapy; ART) is highly effective at suppressing the level of HIV in the blood. After initiation of ART, continued good adherence helps keep HIV suppressed. This suppression has two benefits, as follows:
- It allows the immune system to repair itself sufficiently so that the risk of life-threatening infections that are the hallmark of AIDS becomes extremely low. The power of ART is so transformative that studies increasingly project that many ART users will live well into their senior years.
- Well-designed clinical trials have found that people taking ART who have a suppressed level of HIV have zero risk of transmitting the virus to their sexual partners. Among hundreds or thousands of ART users in a city, region or country, this effect of ART can help to significantly decrease the spread of HIV.
As people with HIV live longer, thanks to ART, they become at risk for other age-related problems seen in people without HIV.
Focus on cancer
When the HIV pandemic was first recognized in the early 1980s, there was no effective treatment available. The life-threatening cancers that commonly occurred in that era were those largely caused by a weakened immune system and included the following:
- Kaposi’s sarcoma (KS)
- non-Hodgkin lymphoma
- invasive cervical cancer
To find out more about trends in cancer diagnoses among people with HIV, a team of researchers across 12 states, including the district of Washington, D.C., as well as Puerto Rico, cooperated and analyzed health-related information collected from more than 800,000 people with HIV between the years 2001 and 2019. During that time, 44,839 new cases of cancer occurred.
The researchers found that the risks for many cancers decreased during the overall study period.
However, in the more recent part of the study (from 2015 to 2019), people with HIV had a heightened risk for the following cancers:
- KS
- Hodgkin lymphoma
- diffuse large B-cell lymphoma
- anal cancer
- cancer of the vulva
- liver cancer
- lung cancer
Although the risk of these cancers remained higher for people living with HIV than HIV-negative people, the researchers observed declining risk for KS, lymphoma and liver cancer among people living with HIV in the latter part of the study. A possible explanation advanced by the researchers for this finding was that over time more people with HIV initiated ART earlier, reducing the period when the virus was able to significantly suppress their immune systems. However, the researchers noted that the risk for some of these cancers was highest in young people, and they stated that this finding “may partly reflect delayed HIV diagnosis and treatment, poorer viral suppression, among younger people with HIV.”
Liver cancer
Although cases of liver cancer declined in the study, the risk of liver cancer remained high, which suggests that more work is needed to cure viral hepatitis infections (hepatitis B and C) among people with HIV in the U.S.
Lung cancer
The researchers noted that although rates of smoking are generally higher among people with HIV, “smoking alone cannot explain the elevated rates of lung cancer, particularly in younger ages” that were seen in the study. They found that diagnoses of lung and liver cancer increased with age among people with HIV.
The researchers projected that the risk of such cancers “will increase as this population grows older.” As these cancers are associated with poor survival, the researchers stated that “lung and liver cancer are poised to be two of the greatest contributors to cancer [deaths] in people with HIV.”
HPV-related cancers
There are many strains of human papilloma virus (HPV), a common sexually transmitted infection. Researchers did not find a decrease in cases of HPV-related cancers, such as anal and vulvar cancer. As cases of vulvar cancer increased over time in the study, the researchers called for more investigation into this issue in women with HIV.
Other body parts
The researchers found that rates of cancers affecting the breast, colon and prostate were stable. However, they found that the risk of these cancers “dramatically increases with older age, and thus, the burden among people with HIV can be expected to increase.”
Reducing cancer risk
The researchers suggested several ways to help reduce cancer risk in people with HIV, as follows:
- Early HIV diagnosis and timely initiation of ART so that levels of this virus are suppressed. The researchers stated that this strategy probably has the greatest effect on diffuse large B-cell lymphoma and KS.
- For cancers driven by coinfections (HBV, HCV and HPV), the researchers noted that vaccines are available for HBV and HPV. Screening and treatment for HBV and HCV are available. Screening programs for anal cancer are increasingly being rolled out.
- Smoking is relatively common among people with HIV, and this drives the risk for many cancers. According to the American Cancer Society, tobacco smoking increases the risk for lung cancer as well as cancers that affect the following parts of the body: mouth, larynx, throat, esophagus, kidney, cervix, liver, bladder, pancreas, stomach, colon/rectum. Tobacco smoking also increases the risk for leukemia. The researchers recommend screening patients for tobacco use and providing “tailored [smoking] cessation programs” to reduce the risk for lung and other cancers.
- Screening for cancers of the liver and lung. The researchers were uncertain whether people with HIV need enhanced screening for these cancers or whether screening recommendations should “follow those [for people without HIV].”
Bear in mind
The current large study is useful and has found trends in cancer risk among people with HIV. The researchers noted that breast, colon and prostate cancers will increase as the population with HIV grows older. Note that as people age the immune system gradually becomes weaker. This may in part explain the increased cancer risk observed in people without HIV and the forecasted increase among people with HIV.
As people with HIV age, screening for cancer and, when necessary, swift referral for treatment will become more important. Healthcare providers can screen for coinfections and offer advice for reducing the risk for drivers of poor health—including insufficient physical activity, obesity, tobacco smoking, problematic substance use, and so on. When necessary, help for these issues can be provided via referrals.
—Sean R. Hosein
Resources
Preventing anal cancer: The importance of HPV vaccination for gay, bisexual and other men who have sex with men – Prevention in Focus
Ontario study looks at trends in cancer in people with HIV – CATIE News
French researchers investigate second cancers in people with HIV who survived a first cancer – CATIE News
Ontario study links low T-cell counts to increased risk for certain cancers in people with HIV – CATIE News
North American study finds low CD4/CD8 ratio can help predict cancer risk in people with HIV – CATIE News
Second cancer risk after surviving Hodgkin’s lymphoma in people with HIV – CATIE News
Trends in liver cancer among HIV-positive people in North America – CATIE News
REFERENCES:
- Haas CB, McGee-Avila JK, Luo Q, et al. Cancer incidence and trends in U.S. adults with HIV. JAMA Oncology. 2025 Jun 12:e251589.
- Trickey A, Sabin CA, Burkholder G, et al. Life expectancy after 2015 of adults with HIV on long-term antiretroviral therapy in Europe and North America: a collaborative analysis of cohort studies. Lancet HIV. 2023 May;10(5):e295-e307.
- Klein MB. Living longer with HIV: gains for some but not for all. Lancet HIV. 2023 May;10(5):e275-e276.
- Uusküla A, Feelemyer J, Des Jarlais DC. HIV treatment, antiretroviral adherence and AIDS mortality in people who inject drugs: a scoping review. European Journal of Public Health. 2023 Jun 1;33(3):381-388.