Cancer screening in women living with HIV infection

Abstract

The number of women living with HIV continues to increase. Thirty years into the AIDS epidemic, we now expect those with access to highly active antiretroviral to survive into their seventh decade of life or beyond. Increasingly, the focus of HIV care is evolving from preventing opportunistic infections and treating AIDS-defining malignancies to strategies that promote longevity. This holistic approach to care includes detection of malignancies that are associated with certain viral infections, with chronic inflammation, and with lifestyle choices. The decision to screen an HIV-infected women for cancer should include an appreciation of the individualized risk of cancer, her life expectancy, and an attempt to balance these concerns with the harms and benefits associated with specific cancer screening tests and their potential outcome. Here, we review cancer screening strategies for women living with HIV/AIDS with a focus on cancers of the lung, breast, cervix, anus, and liver.

Human immunodeficiency virus infection in breast cancer patients: The prevalence thereof and its effect on breast cancer characteristics at Dr. George Mukhari Academic Hospital Breast Clinic, Ga-Rankuwa, South Africa

“…6,18 Cubasch et al observed similarities in the age distribution of HIV in the general population and in HIV patients with breast cancer in Soweto. 6 In line with previous publications, 6,18,23 the most striking finding of our study concerns the difference in age at presentation with breast cancer, which varied based on patient HIV status: the mean age of breast cancer presentation in the HIV-positive group (44.86 ± 9.00 years) was approximately 10 years younger than that of the HIV-negative group (53.18 ± 12.48 years), and of the general population (54.56 ± 13.62 years) ( p < 0.0001) (Figure 3). This raises the question whether HIV-positive patients should be screened for breast cancer at a younger age than the general population.…”

Breast cancer, human immunodeficiency virus and highly active antiretroviral treatment; implications for a high-rate seropositive region

“…These include Hepatitis B-induced Hepatocellular carcinoma and HPV-induced genitourinary, 69 anal, 70 conjunctival, 71 head and neck cancers. 55 These cancers are not associated with a low CD4 count. In contrast to ADC, HAART has had little impact on the incidence of NADC.…”

“…Additionally, HAART has been shown to enhance events seen in biological aging - that is to say HAART accelerates the aging process. 54,55…”

“…Current United States Preventive Service Task Force (USPSTF) screening guidelines recommend, for the general population, a biennial MMG for women age 50-74. 52,55 There are currently no approved guidelines or recommendations for screening WLWHA for BC 55 and most authorities believe that application of national guidelines is appropriate for WLWHA. 52,53,55 Other advocates have suggested that because WLWHA at risk of developing BC at a younger age, they should be considered for an earlier screening MMG exam than the general population.…”

“…52,55 There are currently no approved guidelines or recommendations for screening WLWHA for BC 55 and most authorities believe that application of national guidelines is appropriate for WLWHA. 52,53,55 Other advocates have suggested that because WLWHA at risk of developing BC at a younger age, they should be considered for an earlier screening MMG exam than the general population. 3,8,73 As to the most appropriate way to screen WLWHA, especially those in LMIC is debatable 105,106 and beyond the scope of this article.…”