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.
