By Darryl Fears
Washington Post Staff Writer
Thursday, May 20, 2010; 6:34 PM
When science turned AIDS several years ago from a fatal disease to a chronic illness that often can be managed with drugs, patients and doctors breathed a sigh of relief.
Now they have a new worry.
As people live longer with the virus, they are becoming far more likely than the rest of the population to develop cancers that were not previously associated with AIDS, research has found. "We're seeing high rates of head and neck cancer, lung cancer, kidney cancer, liver cancer and anal cancer," said John F. Deeken, the director of head and neck oncology at Georgetown University Medical Center.
Researchers have detected the trend for years in separate studies around the world, but their findings were not widely publicized or known. On Thursday, the American Society of Clinical Oncology released an abstract by Deeken outlining a clinical trial by the AIDS Malignancy Consortium to study the effects and safety of a chemotherapy drug to treat non-AIDS-related cancers in HIV-positive patients.
Deeken said he hopes the presentation of his research at ASCO's June 4 national conference will call attention to a growing cancer threat and the need to address it. Thousands of oncologists from around the world attend the annual conference to discuss new approaches to cancer treatment.
"Even when we control for smoking, we see a higher rate than the general population," Deeken said. "We don't know why this is happening. We need to figure that out."
Non-AIDS-defining cancers should be a major concern for more than 16,000 District residents who have tested positive for HIV and AIDS, and nearly a million people nationwide, Deeken said.
The District has one of the nation's highest HIV/AIDS prevalence rates, at 3 percent. The development of non-AIDS-related cancers in HIV-infected people could change the way people who are at a greater risk of contracting the virus have come to view the disease.
AIDS activists say that advances in HIV drug therapy have led some young gay men in the District and other cities to think of the disease as a chronic condition that can be easily managed if they became infected.
Robert Yarchoan, chief of the HIV and AIDS Malignancy Branch of the National Cancer Institute, said that medical advances have saved lives but noted that people with HIV "have to take pills the rest of their lives."
"The pills have side effects," he said. "There's premature aging and heart attacks. And now there are these cancers."
In an editorial published last year in Future HIV Therapy, Deeken wrote that HIV patients are 13 to 31 times more likely than the general population to develop Hodgkin's lymphoma. They are twice as likely to have kidney cancer and seven times as likely to have liver cancer.
Barry Donckers of Seattle said he was stricken with cancer after he tested positive for HIV in 1997, even though he was extremely careful to follow his drug regimen.
Donckers noticed blood in his stool six years after his diagnosis. His primary care doctor thought it was caused by hemorrhoids until tests found colorectal cancer.
"They recommend colorectal screening for men at age 50," Donckers said. "I was 42. They never said there was . . . HIV in relation to this cancer. They didn't expect me to live."
Yarchoan said it is not uncommon for primary care doctors not to test for cancer immediately, adding that they are often unaware that patients with HIV are more vulnerable to non-AIDS-defining cancers.
HIV-positive patients were excluded from clinical trials for non-AIDS-related cancers until recently because of their fragile immune systems. Yarchoan said the National Cancer Institute led the effort to include them in trials as improved drug therapies strengthen their immune systems.
Donckers said he is living proof that a person with HIV can survive chemotherapy. "They had concerns. It was risky. But I did 11 treatments. I actually gained 30 pounds. I craved cheeseburgers," he said.
The late cancer diagnosis required reconstructive surgery that makes it hard for him to sit and nerve damage that left him too disabled to work.
"But I'm alive," he said.