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National Cancer Institute Fact Sheet
  • Reviewed: 05/16/2011

HIV Infection and Cancer Risk

Key Points

  1. Do people infected with human immunodeficiency virus (HIV) have an increased risk of cancer?

    Yes. People infected with HIV have a substantially higher risk of some types of cancer compared with uninfected people of the same age (1). Three of these cancers are known as “acquired immunodeficiency syndrome (AIDS)-defining cancers” or “AIDS-defining malignancies”: Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer. A diagnosis of any one of these cancers marks the point at which HIV infection has progressed to AIDS.

    People infected with HIV are several thousand times more likely than uninfected people to be diagnosed with Kaposi sarcoma, at least 70 times more likely to be diagnosed with non-Hodgkin lymphoma, and, among women, at least 5 times more likely to be diagnosed with cervical cancer (1).

    In addition, people infected with HIV are at higher risk of several other types of cancer (1). These other malignancies include anal, liver, and lung cancer, and Hodgkin lymphoma.

    People infected with HIV are at least 25 times more likely to be diagnosed with anal cancer than uninfected people, 5 times as likely to be diagnosed with liver cancer, 3 times as likely to be diagnosed with lung cancer, and at least 10 times more likely to be diagnosed with Hodgkin lymphoma (1).

    People infected with HIV do not have increased risks of breast, colorectal, prostate, or many other common types of cancer (1). Screening for these cancers in HIV-infected people should follow current guidelines for the general population. 

  2. Why do people infected with HIV have a higher risk of cancer?

    Infection with HIV weakens the immune system and reduces the body's ability to fight infections that may lead to cancer (2, 3). Many people infected with HIV are also infected with other viruses that cause certain cancers (2–8). The following are the most important of these cancer-related viruses:

    Infection with most of these viruses is more common among people infected with HIV than among uninfected people.

    In addition, the prevalence of some traditional risk factors for cancer, especially smoking (a known cause of lung cancer) and heavy alcohol use (which can increase the risk of liver cancer), is higher among people infected with HIV (2, 7). 

  3. Has the introduction of antiretroviral therapy changed the cancer risk of people infected with HIV?

    The introduction of highly active antiretroviral therapy (HAART) in the mid-1990s greatly reduced the incidence of Kaposi sarcoma and non-Hodgkin lymphoma among people infected with HIV (2, 5). HAART lowers the amount of HIV circulating in the blood, thereby allowing partial restoration of immune system function.

    Although lower than before, the risk of these two cancers is still much higher among people infected with HIV than among people in the general population. This persistently high risk may be due, at least in part, to the fact that immune system function remains substantially impaired in people treated with HAART. In addition, over time HIV can develop resistance to the drugs used in HAART. Many people infected with HIV have had difficulty in accessing medical care or taking their medication as prescribed (5).

    Although HAART has led to reductions in the incidence of Kaposi sarcoma and non-Hodgkin lymphoma among HIV-infected individuals, it has not reduced the incidence of cervical cancer, which has essentially remained unchanged (2, 5, 6). Moreover, the incidence of several other cancers, particularly Hodgkin lymphoma and anal cancer, has been increasing among HIV-infected individuals since the introduction of HAART (5, 6, 9). The influence of HAART on the risk of these other cancer types is not well understood.

    As HAART has reduced the number of deaths from AIDS, the HIV-infected population has grown in size and become older. The fastest growing proportion of HIV-infected individuals is the over-40 age group. These individuals are now developing cancers common in older age. In 2003, the proportion of these other cancers exceeded the number of AIDS-defining malignancies (6). However, HIV-infected people do not develop most cancers at a younger age than is typically seen in the general population (10, 11). 

  4. What can people infected with HIV do to reduce their risk of cancer or to find cancer early?

    Taking HAART as indicated based on current HIV treatment guidelines lowers the risk of Kaposi sarcoma and non-Hodgkin lymphoma and increases overall survival.

    The risk of lung cancer can be reduced by quitting smoking. Because HIV-infected people have a higher risk of lung cancer, it is especially important that they do not smoke. Help with quitting smoking is available through the National Cancer Institute’s (NCI) smoking quitline at 1–877–448–7848 (1–877–44U–QUIT) and in other NCI resources 1.

    The higher incidence of liver cancer among HIV-infected people appears to be related to more frequent infection with hepatitis virus (particularly HCV) and alcohol abuse or dependence than among uninfected people (7, 13). Therefore, HIV-infected individuals should know their hepatitis status. If blood tests show that they have previously been infected with HBV or HCV, they should consider reducing their alcohol consumption.

    In addition, if they currently have viral hepatitis, they should discuss with their health care provider whether HBV- or HCV-suppressing therapy is an option for them (13, 14). Some drugs may be used for both HBV-suppressing therapy and HAART (13).

    Because HIV-infected women have a higher risk of cervical cancer, it is important that they be screened regularly for this disease. Studies have suggested that Pap test abnormalities are more common among HIV-infected women and that HPV DNA tests may not be as effective as Pap tests in screening these women for cervical cancer (12, 15).

    Some researchers recommend anal Pap test screening to detect and treat early lesions before they progress to anal cancer (16). This type of screening may be most beneficial for men who have had sexual intercourse with other men. HIV-infected patients should discuss such screening with their medical providers. 

  5. How does NCI support research on HIV/AIDS-related cancers?

    The Office of HIV and AIDS Malignancy 2 (OHAM) coordinates and oversees NCI-sponsored research on AIDS-related cancers and HIV/AIDS. OHAM also acts as a point of contact for the National Institutes of Health (NIH) Office of AIDS Research 3 (OAR).

    OHAM has two main programs:

    In addition, the Center for Cancer Research (CCR) and the Division of Cancer Epidemiology and Genetics (DCEG), within NCI's intramural research program, conduct research on HIV and cancer. CCR and DCEG have established the NCI Center of Excellence in HIV/AIDS and Cancer Virology (CEHCV) 10.

    CEHCV's mission is to facilitate and rapidly communicate information about advances in antiviral and immunologic methods for preventing and treating HIV infection, AIDS-related cancers, and cancer-associated viral diseases. CEHCV supports several programs, including the AIDS and Cancer Virus Program 11 and an HIV Drug Resistance Program 12. DCEG also performs research into the risk of HIV/AIDS-associated malignancies through its Infections and Immunoepidemiology Branch 13.

Selected References 

  1. Grulich AE, van Leeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet 2007; 370(9581):59–67. [PubMed Abstract] 14 

  2. Engels EA, Biggar RJ, Hall HI, et al. Cancer risk in people infected with human immunodeficiency virus in the United States. International Journal of Cancer 2008; 123(1):187–194. [PubMed Abstract] 15 

  3. Powles T, Macdonald D, Nelson M, Stebbing J. Hepatocellular cancer in HIV-infected individuals: tomorrow's problem? Expert Review of Anticancer Therapy 2006; 6(11):1553–1558. [PubMed Abstract] 16 

  4. Angeletti PC, Zhang L, Wood C. The viral etiology of AIDS-associated malignancies. Advances in Pharmacology 2008; 56:509–557. [PubMed Abstract] 17 

  5. 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):1645–1654. [PubMed Abstract] 18 

  6. Chaturvedi AK, Madeleine MM, Biggar RJ, Engels EA. Risk of human papillomavirus-associated cancers among persons with AIDS. Journal of the National Cancer Institute 2009; 101(16):1120–1130. [PubMed Abstract] 19 

  7. Silverberg MJ, Abrams DI. AIDS-defining and non-AIDS-defining malignancies: cancer occurrence in the antiretroviral therapy era. Current Opinion in Oncology 2007; 19(5):446–451. [PubMed Abstract] 20 

  8. Grogg KL, Miller RF, Dogan A. HIV infection and lymphoma. Journal of Clinical Pathology 2007; 60(12):1365–1372. [PubMed Abstract] 21 

  9. Simard EP, Pfeiffer RM, Engels EA. Spectrum of cancer risk late after AIDS onset in the United States. Archives of Internal Medicine 2010; 170(15):1337–1345. [PubMed Abstract] 22 

  10. Shiels MS, Pfeiffer RM, Engels EA. Age at cancer diagnosis among persons with AIDS in the United States. Annals of Internal Medicine 2010; 153(7):452–460. [PubMed Abstract] 23 

  11. Spano JP, Costagliola D, Katlama C, et al. AIDS-related malignancies: state of the art and therapeutic challenges. Journal of Clinical Oncology 2008; 26(29):4834–4842. [PubMed Abstract] 24 

  12. Heard I. Prevention of cervical cancer in women with HIV. Current Opinion in HIV and AIDS 2009; 4(1):68–73. [PubMed Abstract] 25 

  13. Macdonald DC, Nelson M, Bower M, Powles T. Hepatocellular carcinoma, human immunodeficiency virus and viral hepatitis in the HAART era. World Journal of Gastroenterology 2008; 14(11):1657–1663. [PubMed Abstract] 26 

  14. McGinnis KA, Fultz SL, Skanderson M, et al. Hepatocellular carcinoma and non-Hodgkin's lymphoma: the roles of HIV, hepatitis C infection, and alcohol abuse. Journal of Clinical Oncology 2006; 24(31):5005–5009. [PubMed Abstract] 27 

  15. Massad LS, Seaberg EC, Wright RL, et al. Squamous cervical lesions in women with human immunodeficiency virus: long-term follow-up. Obstetrics and Gynecology 2008; 111(6):1388–1393. [PubMed Abstract] 28 

  16. Goldie SJ, Kuntz KM, Weinstein MC, et al. The clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive men. Journal of the American Medical Association 1999; 281(19):1822–1829. [PubMed Abstract] 29

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Glossary Terms

acquired immunodeficiency syndrome (uh-KWY-erd IH-myoo-noh-dih-FIH-shun-see SIN-drome)
A disease caused by human immunodeficiency virus (HIV). People with acquired immunodeficiency syndrome are at an increased risk for developing certain cancers and for infections that usually occur only in individuals with a weak immune system. Also called AIDS.
AIDS
A disease caused by the human immunodeficiency virus (HIV). People with AIDS are at an increased risk for developing certain cancers and for infections that usually occur only in individuals with a weak immune system. Also called acquired immunodeficiency syndrome.
anal (AY-nul)
Having to do with the anus. The anus is the opening of the rectum (last part of the large intestine) to the outside of the body.
antiretroviral therapy (AN-tee-REH-troh-VY-rul THAYR-uh-pee)
Treatment with drugs that inhibit the ability of the human immunodeficiency virus (HIV) or other types of retroviruses to multiply in the body.
breast (brest)
Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
cervical cancer (SER-vih-kul KAN-ser)
Cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope). Cervical cancer is almost always caused by human papillomavirus (HPV) infection.
colorectal (KOH-loh-REK-tul)
Having to do with the colon or the rectum.
diagnosis (DY-ug-NOH-sis)
The process of identifying a disease, such as cancer, from its signs and symptoms.
Epstein-Barr virus (ep-stine-BAR VY-rus)
A common virus that remains dormant in most people. It causes infectious mononucleosis and has been associated with certain cancers, including Burkitt lymphoma, immunoblastic lymphoma, and nasopharyngeal carcinoma. Also called EBV.
HAART
Treatment for human immunodeficiency virus (HIV) infection that uses a combination of several antiretroviral drugs. The drugs inhibit the ability of the virus to multiply in the body, and they slow down the development of AIDS. Also called highly active antiretroviral therapy.
head and neck cancer (... KAN-ser)
Cancer that arises in the head or neck region (in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx [voice box]).
hepatitis B virus (HEH-puh-TY-tis ... VY-rus)
A virus that causes hepatitis (inflammation of the liver). It is carried and passed to others through the blood and other body fluids. Different ways the virus is spread include sharing needles with an infected person and being stuck accidentally by a needle contaminated with the virus. Infants born to infected mothers may also become infected with the virus. Although many patients who are infected with hepatitis B virus may not have symptoms, long-term infection may lead to cirrhosis (scarring of the liver) and liver cancer. Also called HBV.
hepatitis C virus (HEH-puh-TY-tis ... VY-rus)
A virus that causes hepatitis (inflammation of the liver). It is carried and passed to others through the blood and other body fluids. Different ways the virus is spread include sharing needles with an infected person and being stuck accidentally by a needle contaminated with the virus. Infants born to infected mothers may also become infected with the virus. Although patients who are infected with hepatitis C virus may not have symptoms, long-term infection may lead to cirrhosis (scarring of the liver) and liver cancer. These patients may also have an increased risk for certain types of non-Hodgkin lymphoma. Also called HCV.
highly active antiretroviral therapy (...AN-tee-REH-troh-VY-rul THAYR-uh-pee)
Treatment for human immunodeficiency virus (HIV) infection that uses a combination of several antiretroviral drugs. The drugs inhibit the ability of the virus to multiply in the body, and they slow down the development of AIDS. Also called HAART.
HIV
The cause of acquired immunodeficiency syndrome (AIDS). Also called human immunodeficiency virus.
Hodgkin lymphoma (HOJ-kin lim-FOH-muh)
A cancer of the immune system that is marked by the presence of a type of cell called the Reed-Sternberg cell. The two major types of Hodgkin lymphoma are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Symptoms include the painless enlargement of lymph nodes, spleen, or other immune tissue. Other symptoms include fever, weight loss, fatigue, or night sweats. Also called Hodgkin disease.
human herpesvirus 8 (HYOO-mun HER-peez-VY-rus...)
A type of herpesvirus that may cause Kaposi sarcoma (a rare cancer that can cause skin lesions) and a type of lymphoma (cancer that begins in the lymph system), especially in patients who have a weak immune system. Also called HHV8, Kaposi sarcoma-associated herpesvirus, and KSHV.
human immunodeficiency virus (HYOO-mun IH-myoo-noh-dih-FIH-shun-see VY-rus)
The cause of acquired immunodeficiency syndrome (AIDS). Also called HIV.
human papillomavirus (HYOO-mun PA-pih-LOH-muh-VY-rus)
A type of virus that can cause abnormal tissue growth (for example, warts) and other changes to cells. Infection for a long time with certain types of human papillomavirus can cause cervical cancer. Human papillomavirus may also play a role in some other types of cancer, such as anal, vaginal, vulvar, penile, oropharyngeal, and squamous cell skin cancers. Also called HPV.
immune system (ih-MYOON SIS-tem)
The complex group of organs and cells that defends the body against infections and other diseases.
incidence (IN-sih-dents)
The number of new cases of a disease diagnosed each year.
infection (in-FEK-shun)
Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
Kaposi sarcoma (kuh-POH-zee sar-KOH-muh)
A type of cancer characterized by the abnormal growth of blood vessels that develop into skin lesions or occur internally.
Kaposi sarcoma-associated herpesvirus (kuh-POH-zee sar-KOH-muh-uh-SOH-see-ay-ted HER-peez-VY-rus)
A type of herpesvirus that may cause Kaposi sarcoma (a rare cancer that can cause skin lesions) and a type of lymphoma (cancer that begins in the lymph system), especially in patients who have a weak immune system. Also called HHV8, human herpesvirus 8, and KSHV.
liver (LIH-ver)
A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.
lung cancer (lung KAN-ser)
Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.
non-Hodgkin lymphoma (non-HOJ-kin lim-FOH-muh)
Any of a large group of cancers of lymphocytes (white blood cells). Non-Hodgkin lymphomas can occur at any age and are often marked by lymph nodes that are larger than normal, fever, and weight loss. There are many different types of non-Hodgkin lymphoma. These types can be divided into aggressive (fast-growing) and indolent (slow-growing) types, and they can be formed from either B-cells or T-cells. B-cell non-Hodgkin lymphomas include Burkitt lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diffuse large B-cell lymphoma, follicular lymphoma, immunoblastic large cell lymphoma, precursor B-lymphoblastic lymphoma, and mantle cell lymphoma. T-cell non-Hodgkin lymphomas include mycosis fungoides, anaplastic large cell lymphoma, and precursor T-lymphoblastic lymphoma. Lymphomas that occur after bone marrow or stem cell transplantation are usually B-cell non-Hodgkin lymphomas. Prognosis and treatment depend on the stage and type of disease. Also called NHL.
Pap test (pap test)
A procedure in which cells are scraped from the cervix for examination under a microscope. It is used to detect cancer and changes that may lead to cancer. A Pap test can also show conditions, such as infection or inflammation, that are not cancer. Also called Pap smear and Papanicolaou test.
penis (PEE-nis)
An external male reproductive organ. It contains a tube called the urethra, which carries semen and urine to the outside of the body.
prostate (PROS-tayt)
A gland in the male reproductive system. The prostate surrounds the part of the urethra (the tube that empties the bladder) just below the bladder, and produces a fluid that forms part of the semen.
risk factor (... FAK-ter)
Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.
screening (SKREE-ning)
Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), and the Pap test and HPV test (cervix). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.
vaginal (VA-jih-nul)
Having to do with the vagina (the birth canal).
virus (VY-rus)
In medicine, a very simple microorganism that infects cells and may cause disease. Because viruses can multiply only inside infected cells, they are not considered to be alive.
vulva (VUL-vuh)
The external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina.

Table of Links

1http://www.cancer.gov/cancertopics/tobacco/smoking
2http://oham.cancer.gov
3http://www.oar.nih.gov
4http://oham.cancer.gov/oham_research/programs/research_africa
5http://www.niaid.nih.gov/labsandresources/resources/cfar/Pages/default.aspx
6http://www.statepi.jhsph.edu/macs/macs.html
7https://statepiaps.jhsph.edu/wihs
8http://oham.cancer.gov/oham_research/programs/consortium
9http://oham.cancer.gov/oham_research/programs/specimen_resource
10https://ccrod.cancer.gov/confluence/display/CEHCV/Home
11http://web.ncifcrf.gov/Programs/Science/Acvp/Default.aspx
12http://home.ncifcrf.gov/hivdrp
13http://dceg.cancer.gov/iib
14http://www.ncbi.nlm.nih.gov/pubmed?term=17617273
15http://www.ncbi.nlm.nih.gov/pubmed/18435450
16http://www.ncbi.nlm.nih.gov/pubmed/17134360
17http://www.ncbi.nlm.nih.gov/pubmed/18086422
18http://www.ncbi.nlm.nih.gov/pubmed/16868446
19http://www.ncbi.nlm.nih.gov/pubmed?term=19648510
20http://www.ncbi.nlm.nih.gov/pubmed/17762569
21http://www.ncbi.nlm.nih.gov/pubmed/18042692
22http://www.ncbi.nlm.nih.gov/pubmed/20696958
23http://www.ncbi.nlm.nih.gov/pubmed?term=20921544
24http://www.ncbi.nlm.nih.gov/pubmed/18591544
25http://www.ncbi.nlm.nih.gov/pubmed/19339941
26http://www.ncbi.nlm.nih.gov/pubmed/18350596
27http://www.ncbi.nlm.nih.gov/pubmed/17075119
28http://www.ncbi.nlm.nih.gov/pubmed/18515523
29http://www.ncbi.nlm.nih.gov/pubmed/10340370
30http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
31http://www.cancer.gov/cancertopics/types/AIDS
32http://www.cancer.gov/cancertopics/types/anal
33http://www.cancer.gov/cancertopics/types/cervical
34http://www.cancer.gov/cancertopics/types/head-and-neck
35http://www.cancer.gov/cancertopics/types/hodgkin
36http://www.cancer.gov/cancertopics/types/liver
37http://www.cancer.gov/cancertopics/types/lung
38http://www.cancer.gov/cancertopics/types/non-hodgkin