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Cancer and HIV

the immune system

There are over 200 types of cancer and three of these are classified as ‘AIDS defining’ cancers under British HIV Association (BHIVA) guidelines.

This means they are more likely to occur if you are HIV positive and have a low CD4 count.


The 'AIDS defining' cancers are:

  • Kaposi’s sarcoma (KS),
  • invasive cervical cancer,
  • non-Hodgkin’s lymphoma.

BHIVA recommends starting treatment as soon as you are diagnosed regardless of your CD4 count. Until recently the recommendation was to start treatment by the time the CD4 count dropped to 350, but this has been dismissed in light of new evidence.

Starting treatment early is important because when your CD4 count is lower than 350, especially if it is lower than 200, your risk of developing HIV-related illnesses is greatly increased.


Non-AIDS-defining cancers

Some cancers are more common in people with HIV, despite not being classified as ‘AIDS defining’. This may be because the underlying cause of some cancers is viral.

Human papillomavirus (HPV)

Anal cancer is linked to the human papillomavirus (HPV) which is a common virus that is passed on sexually, through close physical contact or through sharing sex toys. 

HPV also causes most cases of invasive cervical cancer and some head, neck and oral cancers.

Other cancers which are linked to viruses and have higher rates in people with HIV:

  • Hodgkin’s lymphoma (linked to the Epstein Barr virus)
  • liver cancer (which can be related to hepatitis B or C).

People with HIV have higher rates of ‘modifiable cancer risk’

New American research, published in AIDS, has found higher rates of modifiable risks of cancer in HIV positive people.

Modifiable cancer risks are things like higher levels of smoking, drinking, HPV and hepatitis B and C, and all these were higher among people living with HIV than in the general population.

Each of these pose an increased risk for cancer and can often be avoided with lifestyle changes (hence ‘modifiable’).

The study found:

  • 54% of HIV positive people included in the study were smokers - around two-and-a-half times higher than the general American population.
  • 5% of HIV positive people were co-infected with hepatitis B compared to 0.3% of the general population.
  • 26% of the individuals had chronic hepatitis C compared to 0.9% of the general American population.
  • 46% of women had HPV infection that could lead to cancer compared to 29% of the general US population.
  • 68% of men who have sex with men had anal HPV infection with a risk of leading to cancer, although there were no general population figures available.

Alcohol and risk of cancer

British guidelines on alcohol intake now say that neither men or women should drink more than 14 units of alcohol each week because of links to increased risks of cancer.

Additionally, a recent American study called Veterans Aging Cohort Study (VACS) compared male military veterans to find out whether alcohol was worse for people living with HIV. It found that men drinking more than around 13 units per week were at an increased risk of death than HIV negative men.

This finding just about matches the UKs new guidelines for safe drinking limits of 14 units per week.


What does this mean for me?

In the light of these findings, it is particularly important to look at any lifestyle changes you could consider making if you feel you may be at an increased risk for a particular type of cancer.


What else can I do to reduce my chances of getting cancer?

One in three people will develop cancer in their lifetime.

According to the NHS, small changes to your lifestyle can reduce your risks of developing cancer - such as improving your diet, getting enough exercise, getting enough rest, stopping smoking and cutting down on alcohol.

Staying at a healthy weight and avoiding sun damage to your skin is also important.

Make sure to take up routine testing such as screening for cervical, breast or bowel cancer. Starting antiretroviral treatment straight away can also be preventative.


How is cancer treated?

Most types of cancer are treated with radiotherapy, chemotherapy or surgery although some of the AIDS-related cancers respond well to antiretroviral treatment.

KS, where purple, brown or black lesions appear on the skin and sometimes on the outside of internal organs or in the intestines, is linked to the human herpes virus 8 (HHV8). If you are diagnosed with KS you will usually be given antiretroviral treatment in the first instance as this often causes it to disappear, although if you have KS inside your body you may need to have a different type of treatment such as chemotherapy or radiotherapy.

As people with HIV are now living longer, they have an increased chance of developing cancers generally associated with older age which are not linked to having HIV.


Further support:


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The Information Standard: Certified member

This article was last reviewed on 5/4/2016 by Anna Peters

Date due for the next review: 5/4/2019

Content Author: Kerri Virani

Current Owner: Health promotion

More information:

British HIV Association Guidelines for HIV associated malignancies 2014, by Prof Mark Bower, Dr A Palfreeman, Dr Maryam Alfa-Wali, Prof Chris Bunker, Dr Fiona Burns, Dr Duncan Churchill, Mr Simon Collins, Dr Kate Cwynarski, Dr Simon Edwards, Dr Paul Fields, Dr Kate Fife, Dr Eve Gallop-Evans, Dr Shireen Kassam, Dr Ranjababu Kulasegaram, Prof Charles Lacey, Dr Robert Marcus, Dr Sylvia Montoto, Dr Mark Nelson, Dr Tom Newsom-Davis, Dr Chloe Orkin, Ms Kate Shaw, Dr Melinda Tenant-Flowers, Dr Andrew Webb, Dr Sarah Westwell, Mr Matt Williams, 2014

British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015, September 2015, Duncan Churchill, Laura Waters, N Ahmed, B Angus, M Boffito, M Bower, D Dunn, S Edwards, C Emerson, S Fidler, M Fisher, R Horne, S Khoo, C Leen, N Mackie, N Marshall, F Monteiro, M Nelson, C Orkin, A Palfreeman, S Pett, A Phillips, F Post, A Pozniak, I Reeves, C Sabin, R Trevelion, J Walsh, E Wilkins, I Williams, A Winston

High rates of modifiable cancer risk factors present in Western HIV positive patients, by Michael Carter, January 2016, NAM Aidsmap

Alcohol guidelines review – report from the guidelines development group to the UK Chief Medical Officers, January 2016, Department of Health

New alcohol guidelines show increased risk of cancer, UK Department of Health, January 2016

Summary of the proposed new guidelines, UK Chief Medical Officers’ Alcohol Guidelines Review, Department of Health, January 2016

New Government alcohol unit guidelines, Drinkaware, February 2016

Alcohol units, NHS Choices, April 2015

Moderate alcohol consumption may be more harmful to people with HIV, NAM Aidsmap, Keith Alcorn, February 2016

Macmillan Cancer Support

Who gets cancer?, Macmillan, October 2011

Treatment types, Macmillan, 2011

Non-HIV-related illnesses – cancers, NAM aidsmap, November 2013

Cervical cancer, Michael Carter, Greta Hughson, NAM aidsmap, May 2012

Anal cancer, Michael Carter, Greta Hughson, NAM aidsmap, May 2012

Kaposi's sarcoma, Michael Carter, Greta Hughson, NAM aidsmap, May 2012

Non-Hodgkin's lymphoma, Michael Carter, NAM aidsmap, June 2012

HIV and cancer, i-base, July 2012

Information on cancer and useful links, NHS Choices, September 2014

CD4 cell counts, NAM aidsmap, October 2013

HIV-related illnesses, NAM aidsmap, November 2013

CD4 cell counts, Michael Carter, Greta Hughson, NAM aidsmap, March 2014

Preventing cancer, NHS Choices, December 2013

NHS cancer screening, NHS Choices, December 2013

Human papillomavirus (HPV) and genital warts, Michael Carter, Selina Corkery, NAM aidsmap, October 2013

Starting HIV treatment, Michael Carter, Greta Hughson, NAM aidsmap, February 2012