Certain types of cancer occur so often in people with AIDS that they are considered AIDS-defining conditions -- that is, their presence in a person infected with HIV is a clear sign that full-blown AIDS has developed. They are also called AIDS-related cancers and include the following:

• Kaposi sarcoma
• lymphoma (especially non-Hodgkin lymphoma and primary central nervous system lymphoma)
• invasive cervical cancer

Other types of cancer that may be more likely to develop in people with HIV infection are invasive anal cancer, Hodgkin disease, lung cancer, cancer of the mouth, cancer of the testicles, and skin cancers, including basal cell, squamous cell, and even malignant melanomas. Of course, people without HIV or AIDS can also have all of these types of cancer, even the ones that are better known as AIDS-related. They are only called AIDS-related cancers if they develop in people with HIV infection.

In developed countries like the United States, about 4 people in 10 with AIDS develop cancer at some time during their illness. But the cancer picture in HIV is changing. Kaposi sarcoma and non-Hodgkin lymphoma have decreased as anti-HIV treatment has become more common. It seems that highly active anti-HIV therapy is one of the reasons for the decrease in some types of cancer among those with HIV. Many other types of cancer do not seem to be slowed by HIV treatment, and have the same risk factors as those in people without HIV. For instance, people who smoke and have HIV are more likely to have cancers of the lip, mouth, throat, and lung than people who have HIV and don't smoke.

The relationship between HIV and these other cancers is still not fully understood. However, it is believed cancers can grow quickly because people with HIV have weaker immune systems than those without HIV. Weaker immune systems also make cancers harder to treat. Another factor is the lower white blood cell count that can result from HIV infection. For instance, AIDS can make it hard for a person to take chemotherapy because the bone marrow (which is needed to make new blood cells) is often already damaged by the HIV infection. People with bone marrow damage often can't take full doses of chemotherapy without serious harm.

For those who get cancer, anti-HIV drugs have led to better survival with anti-cancer treatment. Anti-HIV drugs also allow many people with cancer to get full doses of chemotherapy and other standard cancer treatment.

AIDS-related Kaposi sarcoma

Kaposi sarcoma (KS) was once an uncommon disease that mainly affected older men of Mediterranean or Jewish ancestry, organ transplant patients, or young men in Africa. This form is called classic KS or endemic KS. However, in the 1970s and 80s the number of people with KS increased dramatically.

In the past 25 years, most KS cases in the United States have been linked to HIV infection in men who have sex with men. These cases are called epidemic KS. It is now known that KS in people with HIV is related to a second viral infection. This virus is called human herpes virus 8 (HHV-8), also known as Kaposi sarcoma-associated herpes virus (KSHV). HHV-8 does not appear to cause disease in most healthy people. Infection with the HHV-8 is common in the United States among men who have sex with men, but it can also be shared through sex between men and women. The virus is found in saliva, which may be one of the ways it is passed to others.

In most cases, epidemic KS causes dark purplish or brownish spots (called lesions) that can show up at a number of places on the body. The spots may arise on the skin or in the mouth. KS may also affect the lymph nodes and other organs, such as the digestive tract, lung, liver, and spleen.

When they are first diagnosed, some people with HIV and KS have no other symptoms, especially if their only lesions are on the skin. But many -- even those with no skin lesions -- have swollen lymph nodes, unexplained fever, or weight loss. Over time, epidemic KS spreads throughout the body. If KS involves a lot of the lung or intestine, it can be fatal.

In general, people who are diagnosed with epidemic KS are started on anti-HIV drugs, and often get treatment directed at the cancer itself. For more information about KS and its treatment, please see our document, Kaposi Sarcoma.

Lymphomas

Non-Hodgkin lymphoma (NHL) occurs in about 4% to 10% of people with AIDS. It is a cancer that starts in lymphoid tissue and may spread to other organs. The number of HIV-infected people who develop lymphoma has declined since anti-HIV drugs have been in common use.

The non-Hodgkin lymphomas that can happen in people with AIDS are often primary central nervous system (CNS) lymphomas. Primary CNS lymphoma starts in the brain or spinal cord. Symptoms of CNS lymphoma can include seizures, facial paralysis, confusion, memory loss, and lethargy (tiredness). AIDS-related NHL can also include certain types of intermediate and high-grade lymphomas, including Burkitt lymphoma.

The outcome for patients with AIDS-related NHL depends partly on the type of lymphoma and partly on the person's immune function. People with advanced NHL, a helper T-cell count less than 200, and/or who don't get anti-HIV drugs don't usually do as well as people without these factors.

It seems the best treatment for AIDS-related NHL is getting more and more like treatment of NHL in those without HIV infection. At one time, treatment was made up of low doses of chemotherapy. But while taking anti-HIV drugs, many patients can be treated with standard chemotherapy doses.

For patients with primary CNS lymphoma, chemotherapy or whole-brain radiation may be used. Anti-HIV drugs are used to improve immune function and prolong survival.

For more information on HIV/AIDS-associated NHL and its treatment, please see our document, Non-Hodgkin Lymphoma.

Pre-cancerous cervical changes and invasive cervical cancer

HIV-infected women are at high risk for getting cervical intraepithelial neoplasia (CIN). CIN is the growth of abnormal, pre-cancerous cells in the cervix, the lower part of the uterus (womb). Over time, CIN can progress to invasive cervical cancer, in which the cancer cells grow into deeper layers of the cervix.

CIN must be treated to keep it from progressing to invasive cancer. This is done by removing or destroying the outer layers of cervical cells. Studies have shown that untreated CIN is more likely to progress to invasive cancer in HIV-infected women than in women who don't have HIV. The standard treatments for CIN do not work as well in HIV-infected women as they do in women without HIV. The chance of the disease coming back after treatment is high, and seems related to the woman's immune function. Women with T helper cell counts less than 50 are at higher risk for CIN coming back.

HIV-infected women with invasive cervical cancer and a good immune function tend to do well with surgery and the same treatments that women without HIV get. Those who have more advanced disease respond poorly to radiation therapy alone. In women with advanced or recurrent disease, chemotherapy has been used, though the woman must be watched closely after treatment to be sure the cancer doesn't come back. During cancer treatment, the woman's immune status must be watched and her HIV infection treated. Anti-HIV drugs are usually given to improve the treatment outcome for HIV-infected women with invasive cervical cancer, no matter what her T helper cell counts are.

Women with cervical cancer tend to fare better if they do not have AIDS. Women with T helper cell counts higher than 500 have better outcomes. For more detailed information on cervical cancer and its treatment, please see our document, Cervical Cancer.

Non-AIDS -related cancers

With more widespread use of anti-HIV drug treatment, AIDS-related cancers are being seen less often. But as people with HIV are living longer, they are developing cancers that are not generally linked to HIV, such as lung, throat, liver, intestinal, and anal cancers as well as Hodgkin disease and multiple myeloma. Most of the time, treatment includes anti-HIV drugs along with standard cancer treatments. At the same time, any other needed treatments for HIV (such as antibiotics to prevent infections) are used.

Last Medical Review: 09/10/2009
Last Revised: 09/10/2009