Cancer Rates Doubled in HIV+
Here are links to 3 studies/articles on non-AIDS cancers and serious diseases and their death rates: the D.A.D. Study and the French Study report 2 weeks at the Lipodystrophy Workshop in London. Studies are finding that HIV viral load and CD4 count are associated with developing cancers and other comorbidities, so keeping a high CD4 count and undetectable viral load are crucial to preventing these comorobidities and cancers:
Lipo Workshop: CD4 and Undetectable Viral Load Predict Non-AIDS Cancers: "AIDS and non-AIDS defining malignancies in HIV-infected patients - The 2006 ONCOVIH French study" (11/10/08)
deaths from AIDS-defining malignancies (ADM) and non-AIDS-defining malignancies (nADM) in the D:A:D Study
The Collection Adverse Events of Anti-HIV Drugs (D:A:D) Study Group
CD4 Predicts Death: HIV-induced immunodeficiency and mortality ...
Age is also a strong predictor of death from malignancies, suggesting that, at similar CD4 cell counts, older patients are at greater risk of dying from malignancy.
The role of HIV in serious diseases (non-AIDS diseases) other than AIDS - (11/18/08)
older age is a risk factor for these conditions
Risk of lung, other cancers soars for people with HIV
from Jules: mitochondrial toxicity and inflammation !!!!
"people we have treated successfully for HIV at much higher risk for cancer....The reasons aren't fully understood.....patients with HIV are twice as likely as the general population to get any of the cancers not previously linked to the disease. Previous studies have put the risk of developing certain cancers as much as ten times higher for those with HIV.....their immune systems are weakened by disease or injured by antiretroviral drugs; those with HIV are more likely to engage in high-risk behaviors.....The unusual observation is the cancers are occurring at a much younger age....One theory is that HIV depresses the immune system......HIV patients who get cancer don't always have the weakest immune systems, further confounding researchers.....The increased risk of lung cancer in people with HIV, Brock said, is three to five times that for the general population. The risk remains high, he said, even when controlled for smoking. The patients who are appearing at Hopkins, he said, have more late-stage lung cancer, appear to smoke less and are significantly younger than other lung cancer patients. The median age among HIV-positive lung cancer patients is 46; among others it is 64......Dr. Eric Engels, who is studying AIDS and lung cancer at the National Cancer Institute, said lung cancer has not been linked to a cancer-causing virus but wonders whether it might be caused by an unknown infection, scarring in the lungs or some sort of inflammation. If so, that could explain why it is developing more in those with HIV."
By Stephanie Desmon
November 19, 2008
Twenty-five years ago, a diagnosis of AIDS was a nearly immediate death sentence.
But now that patients with the AIDS virus are living longer, doctors are discovering a new set of complications: People with HIV have a much higher risk of developing certain cancers - lung, liver, head and neck, to name a few - and doctors fear that a cancer epidemic among this group could be coming.
Researchers in Maryland, home to one of the nation's largest AIDS populations per capita, are among the leaders in an effort to solve what has become something of a medical mystery.
"We're seeing people we have treated successfully for HIV at much higher risk" for cancer, said Dr. Kevin J. Cullen, director of the University of Maryland's Greenebaum Cancer Center. "The reasons aren't fully understood."
Sun coverage: AIDS in Baltimore Sun coverage: AIDS in Baltimore
New research presented yesterday by a Johns Hopkins epidemiologist at a national cancer conference shows that patients with HIV are twice as likely as the general population to get any of the cancers not previously linked to the disease. Previous studies have put the risk of developing certain cancers as much as ten times higher for those with HIV.
There are some hypotheses for why this is so: HIV patients are simply living long enough to get cancer diagnoses; their immune systems are weakened by disease or injured by antiretroviral drugs; those with HIV are more likely to engage in high-risk behaviors. One prominent researcher wonders whether HIV drugs themselves could be a carcinogen.
What scientists learn about cancer and the immune system could have ramifications not just for those with HIV but also for everyone else.
"We're really at the first stages of systematically looking at the epidemic and fully looking at cancer," said Dr. William A. Blattner, an associate director of the University of Maryland's Institute of Human Virology. "Before, you died from AIDS, so you didn't have time to develop cancer. ... The unusual observation is the cancers are occurring at a much younger age."
Some of the most common cancers being seen among those with HIV are the ones known to be caused by viruses - such as anal and head and neck cancers, which have been linked to the human papillomavirus, and liver cancer, which has been linked to hepatitis.
One theory is that HIV depresses the immune system, allowing cancer-causing viruses to take hold.
Certain cancers have long been associated with HIV and AIDS. Kaposi's sarcoma, non-Hodgkins lymphoma and cervical cancer - all linked to viruses - were seen from the earliest days of the AIDS epidemic. It's the other cancers that are today being seen in much greater numbers, now that HIV in the United States has become a long-term, manageable condition not unlike diabetes.
"There's a real concern about all these cancers and what they portend," said Dr. Mark Wainberg, director of the McGill University AIDS Center in Montreal. "Obviously, we don't want to have an epidemic of cancers in long-term HIV-infected people."
Meredith Shiels, the author of the paper presented yesterday at the American Association for Cancer Research meeting in Prince George's County, said it's possible these cancers might have been seen sooner if antiretroviral drugs had come along years earlier. "Perhaps if they had lived longer, we would have seen this 10 years ago," said Shiels, a doctoral candidate at the Johns Hopkins Bloomberg School of Public Health.
In the 1980s and 1990s, Maryland's Cullen said, "virtually no one [with HIV] who developed cancer could survive rigorous cancer treatment." Antiretroviral drugs have made HIV patients stronger, he said.
Cullen told of a patient of his, a young woman with HIV who had healthy blood counts. When she got head and neck cancer, she was able to tolerate the full-bore treatment and appears to be rid of it. But then she developed pre-malignant lesions in her cervix and recently had to undergo a hysterectomy. She knows that even as she lives with HIV, she is at risk for further cancers. Doctors have found that cancer treatments sometimes don't work as well in immune-compromised people.
Some researchers have suggested that cancers are developing regularly in all of us but that the immune system is able to keep most of them in check. The immune system of a person with HIV might not be able to perform this function as well.
At the same time, HIV patients who get cancer don't always have the weakest immune systems, further confounding researchers.
Researchers at Hopkins and the National Cancer Institute, meanwhile, have been studying the elevated risk of lung cancer in patients with HIV.
In November 2003, Dr. Malcolm Brock, a Johns Hopkins thoracic surgeon, and others noticed that every week at the hospital, there seemed to be another HIV patient being diagnosed with lung cancer. "Finally, we said, 'Something is going on,'" he recalled last week at a conference on HIV and cancer at the University of Maryland School of Medicine.
Johns Hopkins Hospital has a database of about 12,000 patients with lung cancer going back to 1950. In there, researchers found 80 HIV-positive lung cancers, which turned out to be by far the largest such population in any one place - a large enough group to begin studying.
The increased risk of lung cancer in people with HIV, Brock said, is three to five times that for the general population. The risk remains high, he said, even when controlled for smoking. The patients who are appearing at Hopkins, he said, have more late-stage lung cancer, appear to smoke less and are significantly younger than other lung cancer patients. The median age among HIV-positive lung cancer patients is 46; among others it is 64.
"These patients die and they die quickly," Brock said. The average time from HIV diagnosis to lung cancer diagnosis is six years, he said.
"The deaths here were overwhelmingly cancer-related," he said. "They were not due to AIDS."
Dr. Eric Engels, who is studying AIDS and lung cancer at the National Cancer Institute, said lung cancer has not been linked to a cancer-causing virus but wonders whether it might be caused by an unknown infection, scarring in the lungs or some sort of inflammation. If so, that could explain why it is developing more in those with HIV.
Engels said that learning more about how the immune system and cancer interact could have broader application than just helping people with HIV. "This research has implications for people who have a healthy immune system too," he said.
Dr. Robert Redfield, an associate director of the Institute of Human Virology, hypothesizes that some of the malignancies could be due to some of the drugs given over the years to people with HIV to keep them alive.
Wainberg said he worries that there are certain people at high risk for getting HIV who figure they don't have to be concerned about getting the virus because of the strides made in treatment.
"There is no doubt that there are people among vulnerable groups who now have a bit of an attitude of ... 'If I get HIV, the drugs are going to help me anyway,'" he said. They need to know, he said, about the cancer risks.
Engels said none of the talk of cancer risks should diminish the gains that have been made this decade in treating people with HIV in the United States. "If you had to pick a time and a place to live with HIV infection, America today would be the best time and place we've ever had," he said. "But we're finding these problems coming to the surface that we didn't see before."