Cancer has been associated with AIDS before the human immunodeficiency virus was even identified. The association between viruses, the immune system, and cancer has been better explored and defined since the discovery of HIV. Individuals with HIV infection and cancer are faced with two complex life-threatening diseases.

The AIDS defining cancers are Kaposis sarcoma, Non Hodgkins Lymphoma and Cervical carcinoma. All AIDS-defining cancers are caused by or strongly associated with viruses. Kaposi's sarcoma-associated herpesvirus (or human herpes virus 8) in patients with AIDS is normally suppressed by a healthy immune system and can be sexually transmitted causing cancer under biological conditions of immunosuppression. Invasive cervical cancer, another AIDS-defining cancer is associated with the viral agent human papillomavirus. Cervical cancer is a risk for all women, but even more so for women with HIV infection. Non-Hodgkin's lymphoma is associated with Epstein-Barr virus.

Since the advent of highly active antiretroviral therapy (HAART) for HIV infection, and optimal treatment of opportunistic infections, the clinical outcomes for persons living with AIDS have improved substantially.This set of patients in whom severe immunosuppression is not a factor, certain Non_AIDS defining cancers like hodgkins, anal canal cancer, lung, testicular and others are being seen in increased frequencies as compared to the general population. In the current era, HAART as well as better prophylaxis and treatment of opportunistic infections and advances in cancer therapy as well as supportive care, would translate into improved survival and quality of life for patients with HIV and Cancer.

ABSTRACT

1. Survival after cancer diagnosis in persons with AIDS.

Biggar RJ, Engels EA, Ly S, Kahn A, Schymura MJ, Sackoff J, Virgo P, Pfeiffer RM. Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda

J Acquir Immune Defic Syndr. 2005 Jul 1;39(3):293-9.

The survival of persons with AIDS (PWA) has recently improved because of better antiretroviral therapies. Similarly, the prognosis of cancer has also improved. To determine if survival in PWA with cancer has also improved, we compared cancer survival in adults with and without AIDS using data from New York City from 1980 through 2000. Analyses were made for AIDS-related cancers (Kaposi sarcoma, non-Hodgkin lymphoma [NHL], and cervical cancer) and for 8 non-AIDS-related cancers (lung, larynx, colorectum, anus, Hodgkin lymphoma, breast, prostate, and testis). Death hazard ratios compared survival in PWA with cancer with that in cancer patients without AIDS, adjusted for age, sex, race, and calendar-time of cancer occurrence. The 24-month survival rate of PWA with cancer (9015 AIDS cancers and 929 non-AIDS-related cancers of 8 types) improved significantly for most cancer types. By 1996 through 2000, the 24-month survival rate in PWA was 58% for Kaposi sarcoma, 41% for peripheral NHL, 29% for central nervous system NHL, and 64% for cervical cancer. For non-AIDS-related cancers, survival of PWA was lowest for lung cancer (10%) but was >50% for most other cancer types. In 1996 through 2000, significant differences in survival between cancer patients with and without AIDS still remained for Hodgkin lymphoma and lung, larynx, and prostate cancers. We conclude that recent improvements in AIDS and cancer care have greatly narrowed the gap in survival between cancer patients with and without AIDS. Clinicians should be encouraged by the improving prognosis and be diligent about detecting and treating cancer in people living with AIDS.