HIV, Cancer, Us
HIV increases the risk of cancer, especially in long-term survivors
by Hank Trout

If you log on to Facebook, Twitter, or other social media outlets and examine the profile of someone living with HIV, it is not uncommon to read “cancer survivor” among the other details shared. This is especially true among long-term survivors of HIV/AIDS——cancers of one kind or another seem to be among the more common comorbidities that befall those of us diagnosed before the advent of HAART in 1996.

Different colorful ribbons on white wooden background. Photo by iStock

As if we needed something even more deadly than the HIV virus itself to plague us!

According to the National Cancer Institute (NCI), people living with HIV have “a substantially higher risk of some types of cancer” than people in the general population. “Three of these cancers are known as ‘acquired immunodeficiency syndrome (AIDS)-defining cancers’ or ‘AIDS-defining malignancies’: Kaposi sarcoma, aggressive B-cell non-Hodgkin lymphoma, and cervical cancer… People [living] with HIV are currently about 500 times more likely to be diagnosed with Kaposi sarcoma, 12 times more likely to be diagnosed with non-Hodgkin lymphoma, and, among women, 3 times more likely to be diagnosed with cervical cancer.”

Further, those of us living with HIV are at a much higher risk of other kinds of cancer, known generally as “non-AIDS-defining cancers,” such as anal cancer, liver cancer, lung cancer, oral cavity/pharynx cancer, and Hodgkin lymphoma. This increased risk is the result of the HIV virus weakening the immune system and lowering the body’s ability to fight the viral infections that cause cancers.

Even more frightening, the NCI reports that HIV-positive folks with cancer are far more likely to die from it than the general population. “The poorer cancer survival of HIV-[positive] people may result, at least in part, from the weakened immune system in such individuals. The increased risk of death could also result from the cancer being more advanced at diagnosis, delays in cancer treatment, or poorer access to appropriate cancer treatment.”

Grim statistics, indeed, for us long-term survivors of HIV.

The introduction of HAART in 1996 reduced the likelihood of HIV-positive people developing certain cancers, such as Kaposi’s sarcoma and non-Hodgkin’s lymphoma, by lowering the amount of HIV in our blood, allowing partial restoration of our immune system functions. But the rate at which we develop those cancers is still much higher than it is in HIV-negative people. And unfortunately, HAART has done nothing to reduce our risk of other cancers, such as liver and anal cancers, especially in those of us who are over the age of forty.

In the September 2017 issue of this magazine, I described my own experience with cancer. I introduced readers to “Tommy, My Tumor” in a rather flippant description of my diagnosis of appendiceal mucocele, i.e., cancer of the appendix. Despite my attempt at humor in the face of such cancer, I realized that the diagnosis was quite serious; humor was the only way I could face having cancer without breaking down in a sobbing mess.

Fortunately, doctors were able to remove my cancerous appendix via laparoscopic surgery and determine that the cancer was benign. I was indeed fortunate——no more than a week after my cancer diagnosis, I was on the operating table and “Tommy” was cut out of my body.

Perhaps it is the short time between diagnosis and the removal of my cancer that accounts for my difficulty thinking of myself as a “cancer survivor.” Although that is technically accurate, my experience of cancer was so short-lived and so easily dealt with that calling myself a “cancer survivor” seems to blow the situation out of proportion. I didn’t endure the horrors of chemotherapy and/or radiation; I didn’t suffer long months of pain and fear that I would die. When I compare my experience of cancer to that of some of my HIV-positive friends’ experience, claiming to be a “cancer survivor” seems a bit too melodramatic to describe my brief bout with the disease.

But no matter whether I employ that label to describe my own experience, there are things that I and other long-term survivors can do to reduce our risk of cancer. Most important, we must make sure we take our HIV meds routinely, no forgetting, no excuses! Also, stop smoking; cut down on alcohol consumption; get regular anal screenings to catch potential cancers early. HIV-positive women should also be checked regularly for the early signs of cervical cancer. Of course, none of these recommendations can guarantee that we won’t develop one form of cancer or another, but being aware of our increased risk and being vigilant about screening for cancers just might save our lives.

I sincerely hope you never have to meet your own “Tommy.”

Hank Trout, Senior Editor, edited Drummer, Malebox, and Folsom magazines in the early 1980s. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a forty-year resident of San Francisco, where he lives with his husband Rick. Follow him on Twitter @HankTroutWriter.