AIDS and Cancer if it

AIDS and Cancer

If it is not unfortunate enough that individuals must suffer as victims of AIDS, there are also several AIDS- related cancers that more likely occur in individuals infected with the human immunodeficiency virus (HIV). Kaposi sarcoma and non-Hodgkin lymphoma are the most common of these diseases. Other AIDS-related diseases are lung, mouth, digestive tract and cervix cancers. In addition, non-AIDS cancers are also higher for people with HIV. Due to these major cancer risks, health care researchers are trying various approaches, such as antiretroviral therapy, for prevention. In the meantime, reducing risk factors, such as smoking and excessive alcohol, is being recommended. This report focuses further on four studies that provide further information on these subjects.

HIV causes AIDS, which interferes with the body's ability to combat infection and certain forms of cancer. The HIV passes from one person to the next through bodily fluids such as blood. In prior years, before any treatments were possible, most HIV individuals died of infections and certain types of cancer, or what is called AIDS-defining cancers, such as Kaposi sarcoma, non-Hodgkin lymphoma, and advanced cervical cancer (Patel et al.). Since the 1980s, treatments consisting of numerous drugs, or highly active antiretroviral therapy (HAART), have significantly improved health results for HIV-infected patients. As a result, fewer people with HIV infection develop AIDS and the infections and types of cancer related to AIDS.

According to Patel and colleagues, however, those who are treated for HIV infection are living longer than they used to and may have a greater possibility than the general population to be victims of types of cancer that do not indicate AIDS in people with HIV infection. These researchers studied 54,780 people taking part in one of two studies of HIV infection from 1992 to 2003 and established that incidents of AIDS-defining cancer occurred more often with HIV-

infected individuals than the population as a whole. Several non-AIDS-defining cancer forms were more frequently observed among these patients, including anal, vaginal, liver, lung, mouth or throat, colon, and kidney cancer; Hodgkin lymphoma; leukemia; and melanoma. On the other hand, prostate cancer was not as widespread in HIV-infected persons than in the whole population (Patel et al.). As a result of such statistics, it is important for doctors to take greater preventative measures and look for problems of cancer in their AIDS patients at earlier stages of the illness.

As noted, there are certain cancers that are more prevalent with AIDs victims, including those with the gastrointestinal track (Ho-Yen & Fuju Chang). These, for example, include kaposi sarcoma (KS), a cancer that arises from cells lining lymph or blood vessels. KS is the result of the Kaposi sarcoma herpesvirus, also called human herpesvirus 8. Another disease that occurs with the gastrointestinal track is AIDS-related non-Hodgkin lymphoma, a disease where malignant cells are found in the infection-fighting lymph system in AIDS patients. There are also other illnesses that are associated with AIDs and the GI track, such as the auto-immune disease Epstein-Barr virus. Some of these illnesses begin in the anal canal and anal margin and others, such as KS, can begin any place in the GI tract. AIDS-non-Hodgkin lymphoma has a strong tendency to start in the stomach and smaller intestine. Up to 25% of patients with KS have visceral involvement, and the GI tract is commonly affected. Another difficulty for prevention is that patients with GI KS normally do not have symptoms.

Another study by the American Association for Cancer Research similarly concluded that HIV-infected individuals have a much higher risk for non-AIDS cancer than for the public as a whole. In fact, the risk for non-AIDS cancers was over two times higher for males with HIV and one and a half times greater for females with HIV. Meredith Shiels, a John Hopkins School of Public Health epidemiologist, and her colleagues studied the results from 11 global studies that analyzed cancer frequency in HIV-infected individuals. They found a greater risk that appears to be greater among males than females.

As noted above, these researchers also recommend that clinicians of HIV-infected patients inquire about well-known modifiable cancer risk factors. For instance, the people who smoke cigarettes, which results in many types of cancer, are known to be higher among the HIV-infected numbers. AIDS patients should also be very careful on maintaining a well-balanced nutritional diet (Shiels). Doctors who treat AIDS patients should discuss such issues early on in the disease stage with the patients, it is recommended by the researchers.

Although researchers are unaware of the reasons why AIDS patients have such a higher degree of developing some cancers, there are several theories for their higher susceptibility, such as the increased life expectancy due to antiretroviral drugs; weakened immune systems and the likelihood of increased high-risk behaviors as smoking. Some researchers even question if antiretrovirals could be a carcinogen.

The question is whether or not antiretroviral therapy should be given earlier, considering it has shown positive results in some studies. Over the past several years, non-AIDS-defining cancers have gained increasing attention, and it seems that a number of these cancers may have become more common since the HAART treatment began. According to Cinti, Gandhi, and Riddell IV, the overall risk of non-AIDS-defining cancer in HIV-infected individuals is twice to three times that of the regular population. However, these researchers (Cinti, Gahdhi, & Riddel

IV) also state that risk factors above and beyond immunosuppression, including growing older and smoking cigarettes, could have a major role in increasing the risk in HIV-infected people.

These researchers also question if antiretroviral therapy was started as a treatment sooner, would the effect decrease the risk of developing non-AIDS-defining cancer or have an effect on its overall course? Very little data exist regarding how antiretroviral therapy works to protect non-AIDS-defining cancers. Further, there have been no prospective studies in this area. The most helpful research concerning this idea was conducted through a retrospective review of records of HIV-infected persons who had been treated in U.S. military clinics from 1988 to 2003 (as reported in Cinti, Gahdhi, & Riddel IV).