JAIDS Journal of Acquired Immune Deficiency Syndromes:
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS
The human immunodeficiency virus (HIV) infection epidemic was heralded by eruption of Kaposi sarcoma (KS) and aggressive non-Hodgkin lymphoma (NHL), including Burkitt lymphoma, in young homosexual men in the West. Risks for KS and for aggressive NHL were shown to be dramatically elevated (>10,000-fold and 50-600-fold, respectively) prompting these tumors to be designated AIDS-defining. Risks were elevated, albeit modestly, for cervical cancer (10-fold), Hodgkin lymphoma (10-fold), anal cancer (15-30-fold), but not for the most common malignancies in the general population: lung, breast, colon/rectum, stomach, liver, and prostate cancer. Data are scanty for Africa, where the 75% of the epidemic is concentrated. Incomplete case ascertainment and inaccurate diagnosis limit the value of quantitative estimates from Africa. Risk for KS and conjunctival squamous cell carcinoma are 20-90-fold and 10-fold increased with HIV infection. The associations of HIV infection with NHL and cervical cancer are controversial. No association has been shown for many virally-associated cancers, including cancers of the liver, nasopharynx, and penis. The introduction of immune restoring highly active anti-retroviral therapy (HAART) in Western countries in 1996 has decreased acute mortality from HIV and is changing the profile of cancers in people with chronic HIV infection. Access to life-extending HAART has been rapidly expanding since 2002 in Africa and it is dramatically improving survival of patients. The impact of increased survival on cancer burden or relative risk in Africa cannot be predicted from current data, but the HIV treatment cohorts across the continent provide a rare opportunity to study the relationships between cancer, HIV-subtype infection, immunosuppression, and host-genotype. Such studies may reveal new associations of HIV with some virally or not-virally associated cancers. New associations or manifestations of cancer with HIV may become apparent as HAART becomes widely available and HIV survival in developing countries improves.