Most cancers develop over time as a result of exposure to cancer-causing factors in the environment and an accumulation of genetic mutations. People with HIV—who are twice as likely to smoke and who have more cancer-causing coinfections—are at higher risk.
In addition, effective antiretroviral therapy means more HIV-positive people are living to the age when cancer typically occurs. According to the Centers for Disease Control and Prevention (CDC), just under half of people living with HIV in the United States are age 50 or older, and 16% are over 65. About half of all cancers occur in people 65 and older.
Before combination therapy, AIDS-defining malignancies accounted for around 75% of all cancers among people with HIV; today, that figure is closer to 25%. But HIV-positive people are still more likely to develop these cancers than those in the general population, largely because many remain unaware that they have the virus and aren’t on treatment.
“Cancer is a very important cause of mortality in HIV-positive men and women,” says Joel Palefsky, MD, of the University of California at San Francisco, who founded the first clinic devoted to anal cancer prevention. “The AIDS-defining cancers have come down with antiretroviral therapy, but they’re not gone. And the non–AIDS-defining cancers have gone up.”
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