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Cancers Common in Patients with HIV Infection

By

Edward R. Cachay

, MD, MAS, University of California, San Diego School of Medicine

Reviewed/Revised Feb 2023
View PATIENT EDUCATION

AIDS-defining cancers in patients infected with HIV are

Other cancers that appear to be dramatically increased in incidence or severity include

Leiomyosarcoma is a rare complication of HIV infection in children. Also, the rates of other common cancers (eg, lung, head and neck, and cervical carcinomas; hepatomas) are several times higher in patients infected with HIV than in the general population. This finding may reflect, at least in part, greater exposure to the viruses or toxins that cause these cancers: hepatitis B and C for hepatoma, human papillomavirus for cervical, anal, penile, and oropharyngeal carcinoma, and alcohol and tobacco for lung and head and neck carcinomas.

Non-Hodgkin lymphoma

Incidence of non-Hodgkin lymphoma Non-Hodgkin Lymphomas Non-Hodgkin lymphomas are a heterogeneous group of disorders involving malignant monoclonal proliferation of lymphoid cells in lymphoreticular sites, including lymph nodes, bone marrow, the... read more Non-Hodgkin Lymphomas is 50 to 200 times higher in patients infected with HIV. Most cases are B-cell, aggressive, high-grade histologic subtype lymphomas. At diagnosis, extranodal sites are usually involved; they include bone marrow, gastrointestinal tract, and other sites that are unusual in non–HIV-associated non-Hodgkin lymphoma, such as the central nervous system and body cavities (eg, pleural, pericardial, peritoneal).

Common presentations include rapidly enlarging lymph nodes or extranodal masses and systemic symptoms (eg, weight loss, night sweats, fevers).

Diagnosis of non-Hodgkin lymphoma is by biopsy with histopathologic and immunochemical analysis of tumor cells. Abnormal circulating lymphocytes or unexpected cytopenias suggest involvement of the bone marrow, mandating bone marrow biopsy. Tumor staging may require cerebrospinal fluid examination and CT or MRI of the chest, abdomen, and other areas where tumors are suspected.

Poor prognosis is predicted by the following:

  • CD4 count of < 100/mcL

  • Age > 35 years

  • Poor functional status

  • Bone marrow involvement

  • History of opportunistic infections

  • High-grade histologic subtype

Treatment of non-Hodgkin lymphoma is with various regimens of systemic, multidrug chemotherapy that includes cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide. These drugs are combined with IV rituximab and an anti-CD20 monoclonal antibody and supplemented with antiretroviral therapy (ART), prophylactic antibiotics and antifungals, and hematologic growth factors. Therapy may be limited by severe myelosuppression, particularly when combinations of myelosuppressive antitumor or antiretroviral drugs are used. Radiation therapy may debulk large tumors and control pain or bleeding.

Primary central nervous system lymphoma

Primary central nervous system lymphomas consist of intermediate- or high-grade malignant B cells, originating in central nervous system tissue. These lymphomas do not spread systemically, but the prognosis is poor; median survival is < 6 months.

Presenting symptoms include headache, seizures, neurologic deficits (eg, cranial nerve palsies), and mental status changes.

Acute treatment of primary central nervous system lymphomas requires control of cerebral edema using corticosteroids. Although whole-brain radiation therapy and antitumor chemotherapy with high-dose methotrexate alone or combined with other chemotherapy drugs or rituximab are commonly used, none of these regimens has been rigorously evaluated. In observational studies of ART and in a single clinical trial of rituximab, survival appeared improved.

Cervical cancer

Confirmed risk factors for cervical cancer in women infected with HIV include the following:

  • Infection with HPV subtype 16 or 18

  • CD4 count of < 200/mcL

  • Age > 34 years

Management methods for CIN or cervical cancer is not changed by HIV infection. Frequent Papanicolaou tests are important to monitor for progression of CIN. ART may result in resolution of HPV infection and regression of CIN but has no clear effects on cancer.

Squamous cell carcinoma of the anus or vulva

Squamous cell carcinoma of the anus Anal Cancer Anal cancer accounts for an estimated 9760 cases and about 1870 deaths in the United States annually ( 1). The main symptom is bleeding with defecation. Diagnosis is by endoscopy. Treatment... read more Anal Cancer and squamous cell carcinoma of the vulva Vulvar Cancer Vulvar cancer is usually a squamous cell cancer, most often occurring in older women. It usually manifests as a visible or palpable lesion. Diagnosis is by biopsy. Treatment typically includes... read more are caused by the same oncogenic types of HPV as cervical cancers and occur more commonly in patients infected with HIV. The increased incidence of anal intraepithelial neoplasia and cancers in these patients appears to be caused by both high-risk behaviors (eg, anal-receptive intercourse) and immunosupression by HIV; ART may decrease risk of progression.

Anal dysplasia is common, and squamous cell cancers can be very aggressive.

Treatments include surgical extirpation, radiation therapy, and combined chemotherapy with mitomycin or cisplatin and 5-fluorouracil.

Reference

  • 1. Stelzle D, Tanaka LF, Lee KK, et al: Estimates of the global burden of cervical cancer associated with HIV [published correction appears in Lancet Glob Health. 2021 Feb;9(2):e119]. Lancet Glob Health 9(2):e161-e169, 2021. doi:10.1016/S2214-109X(20)30459-9

Drugs Mentioned In This Article

Drug Name Select Trade
Cyclophosphamide, Cytoxan, Neosar
Adriamycin, Adriamycin PFS, Adriamycin RDF, Rubex
Oncovin, Vincasar PFS
Deltasone, Predone, RAYOS, Sterapred, Sterapred DS
Etopophos, Toposar, VePesid
RIABNI, Rituxan, RUXIENCE, truxima
Jylamvo, Otrexup, Rasuvo, RediTrex, Rheumatrex, Trexall, Xatmep
JELMYTO, Mitosol, Mutamycin
Platinol, Platinol -AQ
Adrucil, Carac, Efudex, Fluoroplex, Tolak
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