Cancers in Young and Old and Cancers in HIV

Following on from a symposium on "Current Issues in HIV -related Malignancies" yesterday (webcasts now available) during which HIV  associated malignancies were described as a worldwide epidemic, viral oncogenesis was discussed and a very rapid, high powered presentation on the advances and existing challenges of AIDS lymphoma to be followed immediately by the very humbling presentation on HIV malignancies in low and middle - income countries, it was of great interest to me to attend the themed discussion session on " Cancers in Young and Old and Lung Cancers in HIV"

It was useful to be reminded of the AIDS defining Cancers - Kaposi's Sarcoma, Non Hodgkin's Lymphoma and Cervical cancer and their associated etiological agents as well as the non AIDS defining cancers seen in HIV positive patients including Hodgkins Lymphoma, Anal, Lung and Liver carcinomas with their associated etiological agents.

In the US the most common AIDS defining cancer is Non- Hodgkin's Lymphoma. There have been recent decreases in Non AIDS defining cancers like Lung Ca and Hodgkin's Lymphoma but increases in liver and anal cancers. There was mention of prostate, breast and colorectal cancers although not in excess in HIV patients and with a greater association with ageing.  Aging in the HIV population needs to be considered.

5 studies were elegantly presented at this themed discussion 

• Cancer in HIV infected Children: Record Linkage Study in South Africa
• High Cancer Risk Among HIV Infected Elderly in the United States
• Smoking Outweighs HIV- related risk factors for Non-AIDS Defining Cancers
• High Frequency of Early Lung Cancer Diagnosis with Chest CT in HIV -Infected Smokers
• CD4 Measures as Predictors of Lung Cancer Risk and Prognosis in HIV infection

Key points summarised from these studies

ART was found to reduce the risk of developing cancer in HIV infected children in South Africa and the early link to care as well as the early start of ART is emphasised to further reduce the burden of cancer in these children  

Elderly patients with HIV may have a higher risk for many cancers identified as HIV-associated in younger populations. The elevation of Non-Hodgkin's Lymphoma incidence in this population was notably lower in one of the studies possibly reflecting the high frequency of NHL subtypes less strongly associated with HIV in elderly adults. The increased risk associated with ageing and HIV together, in elderly patients infected with HIV, shows a sizeable absolute risk of cancer. The need for cancer prevention and screening in this population was emphasised.

Smoking cessation programs were emphasised amongst adolescents and young adults at risk for HIVV with suggestions that this could prevent up to 46% of non AIDS defining Cancers in HIV infected adults. This emphasises the importance of primary care involvement in this population. Using ART to preserve immune status, maintain HIV viral suppression and preventing AIDs defining illnesses could prevent only up to 6% of non AIDS Defining Cancers in HIV infected adults. So, effective interventions to reduce smoking were emphasised with a continued HIV treatment focus.

Interestingly , one study showed that early lung cancer diagnosis and nodule followup with chest CT was feasible in HIV infected smokers with detection of surgically curable cancers. This study raised a lot of discussion on screening for lung cancer. I would recommend you look at the webcast when available

Finally another study found several measures of recent and cumulative exposure in immunodeficiency associated with increased risk lung cancer.

Continued vigilance of the issue of malignancy in primary care and specialist care of HIV patients needs to be emphasised.