Changing times: HIV-related cancer risk

Clinical Brief – August 25th

The Brief

Kaposi sarcoma is a type of skin cancer often linked to AIDS. Patients with Kaposi sarcoma are at greater risk of other cancers.

A new study found that the rate of Kaposi sarcoma has come down since the advent of HIV meds. The types of secondary cancers have also changed over time, notably with fewer non-Hodgkin lymphomas and more acute lymphocytic leukemias.

A bit more context?

When someone says Kaposi sarcoma, my first reaction is HIV because it’s known as one of the hallmarks of AIDS. The idea is that HIV decimates the immune system, allowing rare cancers like Kaposi sarcoma to come up.

That said, it’s possible to get Kaposi sarcoma without getting HIV, but I digress.

A study back in ’94 found that patients with AIDS-related Kaposi sarcoma were at risk of getting non-Hodgkin lymphoma. But it’s been a long while since then and HIV meds called ARVs (short for antiretrovirals) have been developed to help keep the virus under control.

Question is, did these meds do anything about the risk of secondary cancers?

The study

Researchers at the University of South Florida looked through the US databases for patients with Kaposi sarcoma between 1973 to 2013 and found nearly 15k cases.

The timeline was cut into three periods: The pre-AIDS era (1973-1979), the pre-ARV era (1980-1995), and the ARV era (1996-2013).

The rate of Kaposi sarcoma in the pre-AIDS era was seen to be 1.5% and went up to 74% in the pre-ARV era. In the ARV era after treatment was introduced, the rate of Kaposi sarcoma dropped notably to 25% (caveat: no stats were run so we can’t be certain of any trends).

On the types of secondary cancers, a majority were anal cancer (50%) and non-Hodgkin lymphoma (49%) back in the pre-ARV era. This was consistent with the older study from 1994.

After ARVs were introduced, anal cancer stayed at 59% and non-Hodgkin lymphoma went down to 13%. During the same period, acute lymphocytic leukemia, a new type of cancer showed up at 18%.

Bottom line

It looks like the advent of ARVs may have helped lower the rates of Kaposi sarcoma for people with HIV, but the risk of secondary cancer remains.

The types of secondary cancers appear to be diversifying.

“Vigilant monitoring and screening for the occurrence of these cancers is important in individuals who are diagnosed as having Kaposi sarcoma.”

– Mukhtar F, et al.

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