Rates of head and neck cancers, including those of the throat, are rising among people living with HIV, particularly in heterosexual men aged 50 and older, according to recent research. While advancements in HIV treatment have significantly extended lifespans for those with the virus, this has been accompanied by an increased risk of certain cancers, highlighting the ongoing immunological challenges faced by this population.
The Link Between HIV and Head and Neck Cancer
Studies have consistently demonstrated a heightened risk of head and neck cancers in individuals with HIV. These cancers encompass tumors affecting the lips, mouth, throat, and voice box, and less frequently, the sinuses. This increased susceptibility isn’t simply a consequence of a weakened immune system, but a complex interplay of factors common in those with HIV.
Traditionally, risk factors for these cancers include excessive sun exposure (affecting the lips), tobacco and alcohol use, and co-infection with viruses like human papillomavirus (HPV) and Epstein-Barr Virus (EBV). However, even with antiretroviral therapy (ART), which effectively manages HIV and boosts immune function, some degree of immunological dysfunction persists. This lingering immune compromise can allow pre-cancerous and cancerous cells to develop and evade the body’s natural defenses.
The Role of the Immune System
A healthy immune system constantly patrols tissues, identifying and destroying pre-cancerous and cancerous cells. In individuals with HIV, even when virologically suppressed by ART, this immune surveillance can be impaired. This allows abnormal cells to proliferate, potentially leading to cancer development. Researchers at Yale New Haven Hospital conducted a study reviewing data from 2002 to 2018, comparing individuals with and without HIV, and found that those with HIV experienced reduced survival rates after a diagnosis of head and neck cancer.
HPV and EBV: Key Viral Contributors
HPV, in particular, plays a significant role in the rising incidence of these cancers. The Gardasil-9 vaccine offers substantial protection against HPV-related cancers, but its effectiveness is greatest when administered before the onset of sexual activity. Unfortunately, many older individuals with HIV did not have access to this vaccine when they were younger, leaving them vulnerable to HPV-related cancers.
EBV is another virus implicated in the development of certain head and neck cancers. Currently, a vaccine to reduce the risk of EBV-related complications is under development, offering a potential future preventative measure.
Recent Trends and Declining Cancer Rates
While the overall risk of head and neck cancer remains elevated in people with HIV, recent data suggest some positive trends in other cancer types. A study published in analyzing data from 12 US states, Washington, DC, and Puerto Rico between and , showed declines in the incidence of several cancers among people with HIV. These included diffuse large B-cell lymphoma (DLBCL), Kaposi sarcoma (KS), Hodgkin lymphoma, lung cancer, and liver cancer. Comparing the years to , researchers observed a 23% decrease in DLBCL, a 24% decrease in KS, a 25% decrease in Hodgkin lymphoma, a 17% decrease in lung cancer, and a 25% decrease in liver cancer.
These declines are likely attributable to improvements in HIV treatment and cancer prevention strategies. However, the study also highlighted that certain cancers, such as prostate, lung, and breast cancer, remained prevalent among people with HIV aged 70 to 84 years.
Implications for Prevention and Screening
The increasing rates of head and neck cancer, coupled with the evolving landscape of other cancers in people with HIV, underscore the importance of proactive prevention and early detection. Vaccination against HPV remains a crucial preventative measure, particularly for younger individuals with HIV. Continued research into EBV vaccines offers hope for further reducing cancer risk.
Regular medical check-ups and screenings are also essential. Individuals with HIV should discuss their cancer risk factors with their healthcare providers and adhere to recommended screening guidelines. Early detection significantly improves treatment outcomes and survival rates. The observed declines in certain cancer types demonstrate the positive impact of improved HIV treatment and prevention efforts, but ongoing vigilance and research are critical to further reduce the cancer burden in this population.
