### Date : 2024-06-20 08:27 ### Topic : Cancers associated with HIV #internalmedicine #medicine #oncology ---- Individuals with HIV (Human Immunodeficiency Virus) are at an increased risk for certain types of cancers, commonly referred to as HIV-associated cancers. These cancers can be broadly categorized into two groups: **AIDS-defining cancers (ADCs)** and **non-AIDS-defining cancers (NADCs)**. ### AIDS-Defining Cancers (ADCs) 1. **Kaposi's Sarcoma:** - Caused by infection with Human Herpesvirus 8 (HHV-8). - Manifests as purple, red, or brown skin lesions but can also affect internal organs. - Common in people with severe immunosuppression. 2. **Non-Hodgkin Lymphoma (NHL):** - Includes various subtypes like diffuse large B-cell lymphoma and primary central nervous system lymphoma. - Linked to Epstein-Barr Virus (EBV) infection in some cases. - Symptoms may include swollen lymph nodes, weight loss, night sweats, and fever. 3. **Cervical Cancer:** - Caused by persistent infection with high-risk types of Human Papillomavirus (HPV). - HIV-infected women are at a higher risk of developing precancerous lesions and invasive cervical cancer. - Regular screening and early treatment of precancerous changes are critical. ### Non-AIDS-Defining Cancers (NADCs) People with HIV are also at increased risk for several other types of cancers not directly classified as AIDS-defining: 1. **Anal Cancer:** - Strongly associated with HPV infection. - HIV-infected individuals, especially men who have sex with men, have a higher risk. - Symptoms include rectal bleeding, pain, or a mass. 2. **Hodgkin Lymphoma:** - Increased incidence in people with HIV. - Often associated with EBV infection. - Presents with lymphadenopathy, fever, night sweats, and weight loss. 3. **Liver Cancer:** - Higher risk due to co-infection with Hepatitis B (HBV) or Hepatitis C (HCV). - Chronic liver disease and cirrhosis are common predisposing factors. 4. **Lung Cancer:** - Increased incidence among HIV-infected individuals. - Smoking prevalence is higher in the HIV-positive population, contributing to the risk. - Symptoms include cough, chest pain, weight loss, and hemoptysis. 5. **Head and Neck Cancers:** - Increased risk, particularly oropharyngeal cancers associated with HPV infection. - Symptoms include persistent sore throat, difficulty swallowing, and a lump in the neck. 6. **Skin Cancers:** - Non-melanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma, are more common in people with HIV. - Increased incidence of melanoma has also been reported. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 40 - **Occupation:** Teacher - **HIV Diagnosis:** Diagnosed 5 years ago, on antiretroviral therapy (ART). **Medical History:** - **Symptoms:** Persistent rectal bleeding, pain during bowel movements, and a palpable mass in the anal region. **Clinical Evaluation:** - **Physical Examination:** Rectal examination reveals a suspicious mass. - **Colonoscopy:** Confirms the presence of an ulcerated lesion in the anal canal. **Biopsy:** - Histopathological examination reveals squamous cell carcinoma, consistent with anal cancer. **Diagnosis:** Based on clinical presentation and biopsy results, Jee Hoon Ju is diagnosed with anal cancer. ### Management 1. **Oncological Treatment:** - **Chemoradiotherapy:** Standard treatment for anal cancer, combining chemotherapy and radiation. - **Surgery:** Reserved for cases where chemoradiotherapy is not effective or feasible. 2. **HIV Management:** - **Continuation of ART:** Ensures immune system support and control of HIV replication. - **Monitoring CD4 Count and Viral Load:** Regular monitoring to assess immune function and ART effectiveness. 3. **Supportive Care:** - **Pain Management:** Appropriate analgesics for symptom relief. - **Nutritional Support:** Ensuring adequate nutrition to support overall health and treatment tolerance. - **Psychosocial Support:** Counseling and support groups to address the emotional and psychological impact of cancer and HIV. ### Conclusion HIV-infected individuals are at an increased risk for certain cancers due to the immunosuppressive effects of the virus and related co-infections with oncogenic viruses like HPV, EBV, and HHV-8. Regular screening, early diagnosis, and integrated management of HIV and cancer are crucial for improving outcomes. Effective antiretroviral therapy plays a significant role in maintaining immune function and reducing the incidence and progression of these cancers.