Cancer Increases Mortality among HIV-Infected Patients

HIV-positive patients are at greater risk of developing concurrent cancer due to the weakening of their immune system. Cancer is in turn responsible for a rise in HIV-related morbidity and mortality. Various cancers can be categorized as NADCs non-AIDS-defining cancers or ADCs (AIDS-defining cancers).

From a general point of view, risk factors for developing cancer among people living with HIV/AIDS (PLWHA) include:

  • Older age
  • low CD4 cell count or late stage of AIDS
  • cigarette smoking
  • co-infection with other viruses
  • alcohol consumption

HIV Moves from Fatal to Chronic

HIV/AIDS has changed from being a fatal disease to a chronic one all over the world with the wide application of antiretroviral therapy (ART). ART has also contributed to a shift in cancer patterns among PLWHA. According to research, the risk of ADCs has been decreasing among HIV/AIDS patients since 1996.

Even so, the burden of NADCs among HIV/AIDS patients is still on the rise. The causes of this rise according to some studies are alcohol consumption and drug abuse with other studies noting older age and lower CD4 counts to be responsible for the increasing mortality of NADCs.

China launched a free nationwide ART program in 2004 and started to provide free ART medications to PLWHA and other related services. Subsequently, the number of deaths of Chinese AIDS patients went down in the following 10 years.

Nonetheless, available information on cancers that are concurrent especially in HIV/AIDS patients living in China is very inadequate. Concurrent cancer identification was made difficult especially in rural China by late identification of HIV infections and under-resourced healthcare settings. Due to this, cancer concurrence prevalence among PLWHA was miscalculated.

Development and Spread of Cancer among HIV-Infected Patients

Jun Yang, Shu Su, Hongxin Zhao, Dennis Wang, Jiali Wang, Fujie Zhang and Yan Zhao carried out a study in Beijing, China, with a focus on the development and spread of cancer in HIV-positive patients at Beijing Ditan Hospital.

The study was based on the theory that ART was protective against concurrent cancer and cancer-related mortality among HIV-infected patients. The researchers were looking to study factors that are at a higher risk of causing concurrent cancer in PLWHAs and those associated with deaths among cancer suffering PLWHAs.

The participants of the study were recruited from the Beijing Ditan Hospital. This was due to the fact that the facility is among largest hospitals that provide healthcare services to HIV-infected people in China not to mention its comprehensive, well-staffed and well-equipped status giving it professional reputation in the state. The hospital hence provided a mixed population of HIV-infected people from all over China making it suitable for the study.

The study involved HIV-infected inpatients admitted at the hospital from January 2008 to December 2013 who were older than 20 years. Patients were considered to be part of the study starting from the first time they were admitted to Beijing Ditan Hospital to the time they die or until the close of the study period in December 2013.

Information for each participant was collected from his/her patient file from the hospital. Information about their demographics, current health status, their CD4 count, ART/survival position were also obtained from the national AIDS information system.

High Death Rates the Cancer-Concurrent Group

A total of 1946 HIV-infected patients were included in the study during the study period. At the end of the study, it was confirmed that indeed alcohol consumption, drug abuse, older age and lower CD4 counts are related factors for developing cancer among PLWHA.

Liver, Hodgkin’s lymphoma, lung and gastrointestinal cancers, were found to be the most prevalent ADCs. Patients without ART were at a higher probability of getting cancer than those who accepted the treatment. Death rates in the cancer-concurrent group were higher and cancer free patients had lower mortality rates observed post study period compared to patients with any of the two types of cancer categories.

The researchers came to a conclusion that HIV-positive patients with cancer have a higher mortality rate than those without. The use of ART is, however, effective in lowering the risk of the patients developing cancer and also reduces the danger of cancer-related deaths in PLWHA.

Our Take

Clearly, early initiation of the use of ART among PLWHA is an important step in reducing the risk of cancer development as well as death due to cancer. HIV-infected people should also be encouraged to frequently screen for cancer.

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Yang J, Su S, Zhao H, et al. Prevalence and mortality of cancer among HIV-infected inpatients in Beijing, China. BMC Infectious Diseases. 2016;16:82. doi:10.1186/s12879-016-1416-3.