HIV infection, aging, and immune function: implications for cancer risk and prevention

Abstract

Purpose of review: Combination antiretroviral therapy (ART) has turned HIV infection into a complex chronic disease. This article documents cancer risk among HIV-infected persons, reviews immune system effects of HIV infection in relation to cancer risk, discusses implications for cancer prevention, and suggests future research directions.

Recent findings: There has been a shift in the cancer spectrum from AIDS-defining cancers (ADC) to non-ADC, although the burden of ADC remains high. Although a high prevalence of non-HIV cancer risk factors among HIV-infected persons contributes to cancer risk, substantial evidence has accumulated in favor of an independent association between HIV-induced immunodeficiency and elevated risk of many specific cancer types, most of viral cause, although further work is needed to disentangle immunodeficiency and smoking effects for lung cancer, and immunodeficiency and hepatitis virus effects for liver cancer. Relationships between cancer risk and two other immune system hallmarks of HIV infection, chronic inflammation, and immune dysfunction/senescence, remain poorly understood.

Summary: Early, sustained ART is a crucial component of cancer prevention. Continued epidemiologic monitoring is needed to detect possible effects on cancer risk of specific ART classes or medications, long-term exposure to systemic inflammation or immune dysfunction, or earlier or more effective ART.

FIGURE 1

Age distribution of persons living with AIDS, USA, 2001 and 2008. We show persons living with AIDS because data were available for all 50 states and the District of Columbia for both 2001 and 2008. For persons living with HIV (with or without an AIDS diagnosis), data were available for 40 states in 2008, but only 33 states in 2001, such that the 2 years were not strictly comparable. Adapted with permission from [3] and [4].