HIV/AIDS Cancer and Impact on Surgical Practice: Implication for the Surgeon

Abstract

Background: The most recent UNAIDS report on the global epidemic estimated the total number of people living with HIV in 2008 to be 33.4 million (31.1-35.8 million) world wide, two-third of known carriers of HIV are living in sub-Saharan Africa. Although HIV prevalence appears to be stable, much remains uncertain about the direction of the epidemic. In the developed countries, the increased cancer risk among immunocompromised persons with HIV/AIDS (PHA) is well observed. Now a person diagnosed with HIV as a young adult in a resourcerich country
can expect to live for 30 or 40 years after infection because of public health education and community awareness in conjunction with advances in antiretroviral therapy. In recent, large scale cohort studies, the incidence of non-AIDS morbidity and mortality rivals that related to AIDS and these non-AIDS conditions including cancer occur at higher rates in those with
on-going HIV replications and lower CD4 cell count. Data Sources/Study selection: Information was obtained by searches of medical journals, examination of reference lists and web resources. Peer-reviewed articles on HIV/AIDS cancer and its impact on surgical practice from references were obtained. Data Synthesis/Conclusion: The severe immunodeficiency
cause by advanced HIV infection has been recognized as capable of causing three types of malignancies: Kaposi’s sarcoma (KS), non-Hodgkin’s lymphoma (NHL) and cervical cancer. Kaposi’s sarcoma and non-Hodgkin’s lymphoma ocur at exceptionally high incidence with relative risk being hundredfold above those in uninfected populations. Cervical cancer is an AIDS-defining cancer when it occurs in HIV-infected woman
and the relative risk is 5 to 10-fold. Although these are the only forms of cancer that have been designated as AIDS-defining, several other malignant diseases have been reported to occur more frequently following HIV infection than in its absence. The distribution of these cancers varies with the sociodemographic characterisitcs of the population studied indicating risk factors for cancer differs amongst populations. There remain
some controversies as to why cancers occur at increased rates. In immunosuppressed PHA, risk of AIDS-related cancer generally increased with degree of immunosuppression. In Hodgkin’s lymphoma, incidence has an inverse relationship with CD4 count. Some tumours are observed more frequently in PHA because of lifestyles that expose them to specific carcinogens such as lung cancer. Other tumours have been reported to have marginal or inconsistent increases in PHA, and their associations
are still controversial. Over the past 20years, AIDS has been transformed
from a disease that was almost inevitably fatal to a chronic
condiiton that is manageable. The longer survival will likely increase the importance of cancer as a clinical problem. In recognition of the increasing importance of cancer as a cause of mortality and mortality in PHA, managing persons affected according to standard practices regardless of HIV status is stressed. These practices should emphasize helping PHA avail high-risk lifestyles such as smoking and screening for early
detection of cancers. Paying detail attention to safety survival practices and appropriating the right choice of procedures for HIV related cancer surgeries in addition to identification of preoperative chronic conditions such as diabetes and hypertension, etc. is important. With the population’s geographic and social diversity, Nigeria also presents unique research
opportunities relating to cancer for the surgeon that can be embedded in programs targeting HIV/AIDS.

Key words: HIV/AIDS, cancer, surgical practice