Cancer risk soars in HIV-infected people -US study

20 May 2008 22:19:11 GMT

Source: Reuters

By Will Dunham

WASHINGTON, May 20 (Reuters) - People with HIV have a much higher risk for many cancers, including anal cancer, but a lower risk for prostate cancer, researchers said on Tuesday.

Some types of cancers like Kaposi's sarcoma and non-Hodgkin lymphoma have long been associated with people infected by the AIDS virus.

The study focused on trends from 1992 to 2003, finding that these two types of cancer became relatively less common among HIV-infected people in the United States . But other cancers are on the rise among these patients, who are living longer thanks to anti-HIV drugs.

Anal cancer by 2003 had become 59 times more common among HIV-infected people than the general population, according to the study in the Annals of Internal Medicine.

Hodgkin's disease was 18 times more common in this population, the study also found. In addition, liver cancer was seven times more common, lung cancer 3.6 times more common, the skin cancer melanoma and throat cancer both three times more common, and colorectal cancer 2.4 times more common.

The study involved 54,780 men and women infected with the human immunodeficiency virus, which causes AIDS.

It found HIV-infected people had a small reduced risk for prostate cancer. The researchers said that may be because men with HIV infections are more likely to have lower testosterone levels, which could be protective against prostate cancer.

"The study was done because we all know that now people with HIV are living longer, and HIV is looking more like a chronic disease. So we wanted to look at one of the other very large chronic killers in America , cancer," Dr. Pragna Patel of the U.S. Centers for Disease Control and Prevention, who led the study, told Reuters.

SCREENING IMPORTANT

Patel said doctors who care for HIV-infected people should be aware of this increased risk for a range of cancer types, and consider screening.

She called the study the largest analysis of cancer trends among HIV-infected people in the United States ever done.

The virus devastates the body's immune system, raising susceptibility to illnesses and infections. Many early AIDS patients developed Kaposi's sarcoma, a cancer previously associated with older people or people receiving immunosuppressant medications following an organ transplant.

But the advent of combination drug therapy in the 1990s called highly active antiretroviral therapy, or HAART, greatly extended the lives of many HIV-infected people, particularly in developed countries.

"Most significant was the finding of anal cancer being so elevated even in the HAART era," Patel said.

She said multiple factors may be involved, but the increased risk may be linked to the fact that anal sex by homosexual men can spread the human papillomavirus, or HPV, which is known to cause anal cancer.

"Of course, anal sex and how many times you have anal sex and how many sex partners you have -- that all matters with regard to HPV infection," Patel said.

Human papillomaviruses are common viruses that can cause warts among other things. About 30 types increase the risk for cancers, including cervical cancer. These are passed through sexual contact with an infected partner. (Editing by Maggie Fox)

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Call for fresh thinking as AIDS pandemic marks quarter century

PARIS (AFP) - New ideas, young talent and injections of money are needed to invigorate the war against AIDS, top experts said here Monday at a review of medical progress since the human immunodeficiency virus (HIV) was discovered 25 years ago.

Men and women in the front line of the combat said there had been some remarkable successes in fighting AIDS.

They hailed the swift identification of the pathogen that causes acquired immunodeficiency syndrome (AIDS) and the advent of the "triple cocktail" of drugs in the mid-1990s that transformed a death sentence into a manageable disease.

But they also spoke of cruel setbacks.

These include the search for a vaccine -- the only way of stopping the global pandemic -- and an HIV-blocking vaginal gel to shield women.

Such failures show basic questions remain to be answered about HIV's shape-shifting properties and its stealthy invasion of immune cells, they said.

"We still don't completely understand the various forms of the virus. It's more complicated for us than we thought," said France's Luc Montagnier, who with Robert Gallo of the United States identified HIV as the cause of AIDS.

"We need to go back to the question of basic research, to have new ideas, new teams, to take a new look at cellular biology," said Jean-Francois Delfraissy, director of France's National Agency for AIDS Research (ANRS).

Alice Dautry, head of the Pasteur Institute, said the next phase of AIDS research called for "a multidisciplinary approach, for looking at the problem through different eyes. When there is a problem, it has to be attacked from every direction."

Gallo called for a rethink of vaccine strategy in the light of two bad flops in this field.

Of the prototype vaccines are in the pipeline, many would be a waste of money and precious resources and could discourage volunteers from taking part, if they were put into costly, large-scale trials, Gallo said.

"Some fundamental biological questions are needed (to be addressed) before some vaccines go forward, or we tend to waste money, produce a depressing atmosphere in the field and take money away from the basic science that is needed right now," he said.

AIDS emerged as a new disease in 1981, initially among US homosexuals. Today, the disease has claimed around 25 million lives and another 33 million are infected.

Gallo attacked what he called a worrying tendency to sideline AIDS as a manageable disease in the age of antiretroviral drugs.

Only a fraction of people living in Africa who need the lifeline therapy actually receive it, he said.

"The [2004 Indian Ocean] tsunami made great headlines, as it should have -- 200,000 people died in one month," he told a press conference at the Pasteur Institute as the three-day meeting got underway.

"But every month, there's an AIDS tsunami -- 200,000 people die of AIDS. Do you think it gets the attention it deserves?"

On May 20 1983, Montagnier's team at the Pasteur Institute published a paper in the US journal Science, describing a virus found in a patient who died of AIDS. Gallo later demonstrated that a virus, found to be the same one isolated by Montagnier, caused the disease.

For several years, an often-bitter dispute unfolded as to who was the first to discover the virus, culminating in a 1987 settlement at top political level under which the duo shared the credit.

"As far as I'm concerned, (the row) was settled over 20 years ago, completely, in every respect," said Gallo, pointing out that he and Montagnier co-authored research papers these days.

Montagnier said he was "completely in agreement... there were legal problems, problems about intellectual property that were resolved above our heads."

Experts call for increased focus on hepatitis

GENEVA (AFP) - Chronic hepatitis, which infects 10 times more people than HIV, should be given the same attention such as AIDS, tuberculosis and malaria, the World Hepatitis Alliance said Monday.

"Although it is estimated that 500 million, approximately one in 12 people are infected with either chronic viral hepatitis B or C globally, there is a serious lack of awareness and political will to tackle these diseases" said the group on the sidelines of the annual meeting of the World Health Organisation.

Some 1.5 million people die every year from a hepatitis disease, making it "one of the biggest threats to global health," the non-governmental group said.

"We need to give these diseases the same visibility as for AIDS, tuberculosis and malaria," said Charles Gore, president of the umbrella NGO which groups 200 organisations of patients with hepatitis B and C.

One of the major problems encountered by the scientists is the lack of information at their disposal.

"There is no central source that coordinates these statistics on hepatitis," said professor Shivaram Prasad Singh, chairman of Kalinga Gastroenterology Foundation.

The alliance also launched a Hepatitis Atlas, calling on governments and organisations to provide relevant information and statistics.

In addition, scientists also highlighted the responsibility of governments not just on diffusing information on the disease, but also in policies.

"I was recently in Mozambique and I found that they do not screen blood used for transfusions for hepatitis," said Jean-Michel Pawlotsky, secretary general of the Association for the Study of the Liver.

Some 350 million people worldwide are infected with the hepatitis B virus, a severe liver infection.

It is transmitted by direct blood contact or other bodily fluids.

Unlike hepatitis B, however, there is no vaccine against hepatitis C, which affects 130 million people.