People living with HIV encouraged to know their cancer risk

With just over seven million South Africans living with HIV, it’s important that the increased risk of cancer in people with HIV is recognised as a real concern, the Cancer Association of South Africa (CANSA) said.

On World AIDS Day (Sunday, 1 December), CANSA, the National Department of Health, National Cancer Registry (NCR) and Southern African HIV Clinicians Society highlighted that the human immunodeficiency virus (HIV) is a cancer-causing agent and can put people living with HIV at risk for cancer.

“Dedicated antiretroviral therapy (ART) adherence, adopting a healthy lifestyle, regular exercise and cutting out tobacco and alcohol are resulting in people living with HIV living a healthy and full life. CANSA wants to encourage people living with HIV to reduce their cancer risk and know the signs and symptoms of the most common cancers affecting people living with HIV as early detection improves treatment outcomes,” said Dr Melissa Wallace, Head of Research at CANSA.

Dr Elvira Singh, Head of the NCR elaborated, “Our recent study examined national cancer trends and excess cancer risk in people living with HIV compared to those who are HIV-negative. The study found that people living with HIV are at higher risk of AIDS-defining cancers namely, Kaposi sarcoma, non-Hodgkin’s lymphoma and cervical cancer.

“They’re also at increased risk of conjunctival cancer and human papillomavirus (HPV) related cancers which include: penile, anal and vulvar cancer, compared to HIV-negative patients. Squamous cell carcinoma of the skin has also been found to be HIV-associated. The risk of Kaposi sarcoma has declined as antiretroviral therapy (ART) became available. However, the risk of conjunctival cancer and HPV-related ano-genital cancers (cervical, anal, vulvar and penile cancers) continues to rise, despite widespread availability of ART,” said Singh.

“To lower personal risk of cancer and to promote early detection, people living with HIV should initiate ART early and adhere to ART to lower the risk of Kaposi sarcoma and non-Hodgkin’s lymphoma. Early initiation of ART has been enabled by the Universal Test and Treat policy in South Africa which allows for initiation of ART regardless of CD4 count. Additionally, cervical cancer screening in HIV-positive women should be done at HIV diagnosis, and every three years (yearly if screening test is positive) according to the recommendations of the SA Cervical Cancer Policy,” added Wallace.

According to Dr Melissa Wallace, common symptoms of HIV-related cancers include:

• Kaposi sarcoma: Slightly elevated purple/ pink (on white skin); brown/ black (on darker toned skins); or red blotches or bumps anywhere on the skin or in the mouth and/ or throat; swelling of the legs; caused by a blockage of the lymphatic system.

• Cervical cancer: May have no symptoms in early stages; increased vaginal discharge; maybe foul-smelling discharge; pain or bleeding during sexual intercourse.

• Hodgkin’s and non-Hodgkin’s lymphoma: Painless, swollen lymph nodes in the neck, armpits or groin; persistent fatigue, fever, night sweats; unexplained weight loss.

• Conjunctival cancer: A white, painless, progressive growth on the surface of the eye; may have associated photophobia, redness of the eye, irritation and foreign body sensation.

• Anal cancer: May have no symptoms in early stages; blood or mucous in stools (faeces) or on toilet paper; itching; discomfort or pain around the anus; a feeling of fullness, discomfort or pain in the rectum; a lump near the edge of the anus or ulcers around the anus.

• Vulvar cancer:

Thickening/ roughness of the skin of the vulva; itching, pain or burning; lump or open sore on the vulva; bleeding or discharge not related to the normal menstrual period.

• Penile cancer: A growth or sore on the penis that does not heal in four weeks; bleeding from the penis or foul-smelling discharge from under the foreskin; thickening or discolouration of the skin on the penis.

• Squamous cell carcinoma of the skin: A wart-like skin growth, or a persistent, scaly red patch with irregular borders that may bleed easily; an open sore that persists for weeks; a raised growth with a rough surface and a central depression.

CANSA encouraged screening as early diagnosis allows more effective treatment. Its Care Centres country-wide offer Pap smears, a liquid-based cervical cancer screening test for early diagnosis. Further screenings include clinical breast examinations, skin examinations using a FotoFinder to examine moles, and Prostate Specific Antigen (PSA) blood tests to assist in detecting prostate abnormalities, all at very affordable rates.