The Cancer Association of South Africa

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World AIDS Day (1 December)

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

HIV and Cancer slideshow

HIV and cancer infographic

What is HIV?

HIV is an infection that can lead to AIDS (acquired immunodeficiency syndrome). It's a virus that breaks down certain cells in the immune system (the body's defence against diseases that helps a person stay healthy).

What causes HIV infections?

The infection is caused by the human immunodeficiency virus and is spread when blood, semen, or vaginal fluids from an infected person enter another person's body, usually through sexual contact, from sharing needles when injecting drugs, or from mother to baby during birth.

How does HIV affect the human body?

The virus can survive and multiply in the human body and in doing so infects, and destroys, the CD4 cells of the immune system. This makes it more difficult to fight off other infections and certain cancers.

How is HIV treated?

Antiretroviral therapy (ART) is used to treat HIV infection and may consist of a regimen of HIV medicines. These medicines work to reduce the amount of virus in the body thereby limiting destruction of immune cells. Reducing the amount of virus in the body can help to lessen the chance of transmission of HIV and reduce the risk of some cancers.

What is the link between HIV and cancer?

It is important for those living with HIV as well as healthcare providers to be aware of the symptoms of cancer, as HIV puts people at higher risk for cancer.

Dr Elvira Singh, Head of the National Cancer Registry explains, “Our recent study* examined national cancer trends and excess cancer risk in people living with HIV (PLWH) compared to those who are HIV-negative. The study found that PLWH 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 papilloma virus (HPV) related cancers which include: penile, anal and vulvar cancer, compared to HIV-negative patients. Squamous cell carcinoma of the skin was also been found to be HIV-associated. The risk of Kaposi sarcoma has declined as 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.”

* Dhokotera, T., Bohlius, J., Spoerri, A., Egger, M., Ncayiyana, J., Olago, V., Singh, E. and Sengayi, M., 2019. The burden of cancers associated with HIV in the South African public health sector, 2004–2014: a record linkage study. Infectious agents and cancer, 14(1), p.12.

How can those with HIV lower their cancer risk?

“In order to lower personal risk of cancer and to promote early detection, PLWH 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. Dedicated antiretroviral therapy (ART) compliance, adopting a healthy lifestyle, regular exercise and cutting out tobacco and alcohol are resulting in PLWH living a healthy and full life. Additionally, cervical cancer screening in HIV-positive women should be done at HIV diagnosis, and every 3 years (yearly if screening test is positive) according to the recommendations of the SA Cervical Cancer Policy,” says Dr Melissa Wallace, Head of Research at CANSA.

Kaposi sarcoma

Slightly elevated purple / pink (on white skin); brown / black (on darker tone 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; 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 4 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.

How CANSA Helps:

CANSA urges PLWH to be aware of the symptoms of cancer as early detection improves treatment outcomes, and to initiate and continue with ART. CANSA also encourages screening as early diagnosis allows more effective treatment. It’s 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 detecting prostate abnormalities, all at very affordable rates. PLWH diagnosed with cancer may contact their local CANSA Care Centre for counselling and support.

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