HIV, cancer, and aging

Abstract

As people with HIV age, they will experience increasing rates of all diseases of aging, including cancer. However, the pattern of higher cancer risk in people with HIV is mostly explained by the chronic effects of certain oncogenic infections, and is not consistent with a syndrome of accelerated aging. Many of those cancers that are most closely associated with aging do not occur at increased rates in people with HIV compared with the general population. The risk of many infection-associated cancers in people with HIV is closely related to the degree of immune deficiency, and for some types of cancer, it is also associated with ongoing HIV replication. Thus, if HIV therapy can provide durable HIV suppression and maintain near normal levels of immune function, the excess risk of cancer is likely to be minimised. While avoidance of profound immunity will greatly reduce cancer risk, it is unclear how close to normal immune function must be to minimise HIV-associated cancer risk. People with HIV are also at a high risk of cancer because they have high rates of lifestyle risks for cancer, in particular tobacco and alcohol exposure. For most cancers, it is appropriate to follow general population guidelines on cancer screening. The exception is cervical cancer, for which annual screening is recommended. In addition, active research is required to establish whether anal cancer screening would prevent the unacceptably high levels of morbidity caused by this disease in people with HIV, most particularly in gay men.