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HIV/AIDS Cancer Match Study

People living with HIV have a higher risk of certain types of cancer. This high risk occurs because HIV infection weakens the immune system, and because many other cancer risk factors are common among people living with HIV. Investigators at the NCI seek to better understand the role of the immune system and certain infections in the development of cancer. Understanding pattens of cancer occurrence in the population of people living with HIV may help identify important opportunities for cancer prevention.

The HIV/AIDS Cancer Match Study (HACM) is an observational study of nearly 1 million people with HIV across multiple regions of the United States. The HACM Study is a long-standing collaboration between the National Cancer Institute, state health departments and universities. The study uses public health surveillance information on people living with HIV and cancer, both of which are notifiable conditions to health departments. Health departments merge their disease-specific registries to construct a new database resource through which to study cancer risk among people living with HIV. This study does not recruit patients, and all identifiable information is removed from files used by researchers at the National Cancer Institute.

The HACM Study focuses on the modern era of widespread introduction of antiretroviral therapy starting in 1996 through the present time. The HACM Study has made important contributions to public health, including characterizing trends in cancer risk over the course of the entire HIV epidemic, understanding shifts in the projected cancer burden among aging populations on long-term antiretroviral therapy, and describing disparities in treatment and outcomes following a cancer diagnosis.

Higher risk of cancer among people living with HIV

People living with HIV have a high risk of developing certain types of cancers, including Kaposi sarcoma, non-Hodgkin lymphoma, and cancers of the cervix, lung, liver, and anus. This high risk occurs because HIV weakens the immune system. Also, people living with HIV frequently have other cancer-causing viruses at the same time. Tobacco and alcohol use increase the risk of certain cancer types.

Cancers for which people living with HIV have an elevated risk:

  • Kaposi sarcoma (KS): This cancer is caused by human herpesvirus 8, also known as KS-associated herpesvirus. Combination antiretroviral therapy (cART) reduces the risk of this cancer.
  • Non-Hodgkin lymphoma (NHL): In many cases, this cancer is caused by Epstein Barr virus. cART reduces the risk of this cancer.
  • Cervical cancer: This cancer is caused by human papillomavirus. Women living with HIV should receive regular screening for cervical cancer from their HIV provider or a gynecologist. Screening consists of a pelvic exam, during which the provider obtains a Pap smear and testing for high risk strains of human papillomavirus. Screening can detect early stages in the development of cancer, which can be treated to prevent progression.
  • Lung cancer: This cancer is caused by smoking, which is very common in some HIV populations. People living with HIV appear to be especially susceptible to the cancer-causing effects of tobacco. HIV-infected people should work with their healthcare provider to quit smoking. Medications and counseling can increase the chances of successfully quitting tobacco use. Individuals should also discuss the possible benefits of screening for lung cancer using low-dose computed tomography (CT) scanning, which is recommended for long-time smokers in the general population.
  • Anal cancer: This cancer is caused by human papillomavirus. People who have had anal intercourse are at especially high risk, but the cancer can also occur among other groups of people living with HIV.
  • Liver cancer: This cancer is caused by infection with hepatitis B virus (HBV) and hepatitis C virus (HCV), and also by excessive alcohol intake and obesity. People living with HIV should receive the HBV vaccine, if they have not already been infected with HBV. Treatment for HBV and HCV can result in clearance or suppression of these viruses. People living with HIV who also have HBV or HCV infection should be monitored for liver damage and should moderate their use of alcohol.

Cancers for which people living with HIV do not have an elevated risk:

  • Colon cancer
  • Breast cancer
  • Prostate cancer

These cancers are common in the general population, and people living with HIV do not have an increased risk compared with people who do not have HIV. Because effective therapy now allows people with HIV to live longer healthier lives, they should receive the same screening for these cancers as people in the general population.

Selected publications

Hernandez-Ramirez RU, Shiels MS, Dubrow R, Engels EA. Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study. The Lancet HIV. 2017;4(11):e495-e504.

Engels EA, Pfeiffer RM, Goedert JJ, et al. Trends in cancer risk among people with AIDS in the United States 1980-2002. AIDS. 2006;20(12):1645-54.

Shiels MS, Islam JY, Rosenberg PS, Hall HI, Jacobson E, Engels EA. Projected Cancer Incidence Rates and Burden of Incident Cancer Cases in HIV-Infected Adults in the United States Through 2030. Annals of Internal Medicine. 2018; 168(12): 866-73.

Shiels MS, Pfeiffer RM, Gail MH, et al. Cancer Burden in the HIV-Infected Population in the United States. J Natl Cancer Inst. 2011 May 4;103(9):753-62.

Suneja G, Shiels MS, Angulo R, et al. Cancer treatment disparities in HIV-infected individuals in the United States. J Clin Oncol. 2014 Aug 1;32(22):2344-50.

Suneja G, Shiels MS, Melville SK, Williams MA, Rengan R, Engels EA. Disparities in the treatment and outcomes of lung cancer among HIV-infected individuals. AIDS. 2013 Jan 28;27(3):459-68.