The rate of non-AIDS defining cancer is now as much as 3 times higher in older adults with HIV when compared to controls. Some of this increase is to be expected as people age. The rates vary depending on the types of cancer. Rates are higher for certain cancers – anal, Hodgkin’s lymphoma, liver and lung cancer, while there are lower rates for breast, prostate, and colon cancers. However, several studies have suggested that older persons with HIV seem to develop more advanced cancers, which are more aggressive. The reasons for this finding are not clear. One reason might suggest that screening does not occur regularly in this population. A well-known study of veterans that compared those with and without HIV followed over time, found that the rate of cancer was higher but occurred at about the same time. This observation could be an indicator that there was not accelerated aging in this cohort.
HIV AND THE CAUSES OF CANCER
A major factor in causing cancer is probably the direct effect of the virus on vulnerable tissues. The virus may attack the cell cycle and related genes that cause cancer cells to grow. This makes sense since the aggressive treatment of HIV has resulted in a decrease in the rates of occurrence of some cancers. However, other cancers have not experienced this decline, so the pathology is not so clear. HIV infected patients have also been exposed to other cancer promoting viruses, such as hepatitis B and C, as well as human papillomavirus and Epstein Barr virus that attack various tissues, especially the liver. Finally, tobacco is a major cause of lung cancer as well as head and neck tumors. Unfortunately, smoking is higher in older adult with HIV when compared to the general population.
TALK TO YOUR DOCTOR ABOUT YOUR CONCERNS AND THE NEED TO CONDUCT TESTS FOR CANCER OFTEN
Because of the higher frequency of some cancers in older adults with HIV, the physicians that supervise care need to do regular screening for cancer on patients according to existing protocols. Although there are no specific guidelines for HIV patients, age specific screening needs to occur. Also, target areas, such as the vagina and anus, should have Pap smears done more frequently. Without this attention the risk of identifying cancer cases late is a real possibility.
BE ALERT AND MAKE CERTAIN SCREENING IS DONE
The approach to treatment must fit high standards, including surgery, high dose chemotherapy, and radiation depending on site and circumstances. Also, there must be close coordination between the managing physician and the oncologist. Older persons with HIV are more vulnerable to complications because of potential medication interactions and a compromised immune system. These efforts can result in a satisfactory recovery and a return of function. Of course, better prevention, including regular screening of older adults with HIV, should effectively find cancer during its early stages. If you think your doctor is not screening often for cancers, then ask for the tests to be done.
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