Advances in HIV care have shifted its status from a deadly disease to a chronic condition. In fact, cancer has become one of the leading causes of death for people living with HIV, a trend driven by the burden of AIDS-defining cancers, immunodeficiency, and health disparities.1 In addition, antiretroviral therapy is extending the lives of people living with the virus, consequently leading them to live long enough for these cancers, unrelated to their HIV status, to develop.
At the American Association of Nurse Practitioners (AANP) annual meeting, held from June 17 to 22, 2025, in San Diego, California, Melody Wilkinson, DNP, APRN, FNP-C, FAANP, and Karen McCrea, DNP, APRN, FNP-C, presented evidence-based cancer screening and prevention strategies that primary care providers can implement for early detection, routine surveillance, and management of modifiable risk factors to improve outcomes for people living with HIV.2 This begins with HIV testing, Dr Wilkinson told The Clinical Advisor.
“We have approximately 1.2 million people living with HIV in the United States, and of those, 13% are still unaware or undiagnosed,” she said.3 “Recognizing that we have many people with HIV who have not been identified, testing, diagnosing, and treating HIV becomes fundamentally important.”
Dr Wilkinson emphasized the importance of recognizing the gap between infection, diagnosis, and treatment in primary care, including routine screening and testing, and then providing “good coordination of services across the spectrum of care.”
HIV Management in Primary Care
With advances in HIV therapy, health care providers need to introduce the same lifelong health promotion practices that they implement with their HIV-negative patients, Drs McCrea and Wilkinson explained.
“Making that shift away from just addressing the HIV and making sure that we’re addressing those lifelong health promotion and disease prevention topics is important,” Dr McCrea said in an interview with The Clinical Advisor.
Although the medical community has made significant strides in HIV treatment, the diagnosis remains heavily stigmatized. Stigma and other social and structural determinants of health influence the extent to which people living with HIV are able or willing to access health care.4
“We know that this patient population experiences more vulnerabilities and greater impacts of social determinants of health than the general population, so things like access to medical services, funding sources, and stigma significantly impact people living with HIV and their access to timely medical services,” Dr Wilkinson said.
Timely care, which includes regular cancer screening and early intervention, is particularly important for people living with HIV because they develop cancer at a higher rate than the general population and have an increased risk for complications, relapse, and death.5-7
Cancer Risk for People Living With HIV
Antiretroviral therapy does mitigate risk for developing AIDS-defining cancers, such as Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical cancer, but it does not fully eliminate the threat. Similar to the general population, aging and substance use increase non-AIDS-defining cancer risk for people living with HIV, said the authors. Non-AIDS-defining cancers include oncogenic and solid organ tumors; lung and anal cancers account for almost half of non-AIDS-defining cancers in people living with HIV.8
Currently, clinicians have to rely on the same screening tools that they use for the general population for their patients living with HIV. There is a need for HIV-specific cancer screening tools for non-AIDS-defining cancers, Drs Wilkinson and McCrea noted.
“We know that individuals who have HIV have poorer outcomes with cancers, higher rates of cancers, they are more likely to present abnormally, and they are more likely to progress quicker,” Dr McCrea said. “With that in mind, it should be important to have screening guidelines that recognize the unique risks and address them in a way that’s appropriate for that population. Instead, for many of these cancers, we’re screening basically under the guidelines for the general population, recognizing that there’s inherent risks in that.”
AIDS-Defining Cancers Versus Non-AIDS Defining Cancers
There are 3 types of AIDS-defining cancers: Kaposi sarcoma, B-cell non-Hodgkin lymphoma, and cervical cancer, but only cervical cancer has screening guidelines.
“Providers need to have a threshold of awareness that these are cancers that may present in individuals with HIV and consider those differentials when they are taking histories and on physical exams with patients,” Dr Wilkinson said (Table 1).9
Table. AIDS-Defining vs Non-AIDS Defining Cancers
| Cancer | Virus | Definition | Notes for people living with HIV |
| Kaposi sarcoma | Human herpesvirus-8 | AIDS-defining | |
| B-cell non-Hodgkin lymphoma | Human herpesvirus-8 | AIDS-defining | |
| Cervical cell carcinoma | HPV 16&18 | AIDS-defining | People with HIV are 6 times more likely to be diagnosed than non-HIV individuals. HPV persists longer and progresses faster in people living with HIV. |
| Squamous cell carcinoma | HPV 16&18 | Non-AIDS defining | |
| Anal cell carcinoma | HPV 16&18 | Non-AIDS defining | HIV-positive men who have sex with men are 37 times more likely to be diagnosed than the general population. Individuals who engage in anal receptive sex, have abnormal cervical Pap results, or have anogenital warts are also at increased risk. |
| Liver adenocarcinoma | Hepatitis B&C | Non-AIDS defining | |
| Smooth muscle tumor | Epstein-Barr virus | Non-AIDS defining | |
| Oral pharyngeal | HPV 16&18 | Non-AIDS defining | Risk factors include tobacco use, alcohol consumption, and exposure to HPV. Rates in HIV+ people mimic those of the general population. |
| Colorectal | JC virus | Non-AIDS defining | |
| Breast | Non-AIDS defining | People living with HIV are more likely to smoke than the general population, but even when studies are controlled for smoking, HIV+ people still have a higher incidence. | |
| Lung | Non-AIDS defining | People living with HIV are more likely to smoke than the general population, but even when studies are controlled for smoking, HIV+ people still have a higherincidence. |
Advancing Cancer Screening and Prevention for People Living With HIV
Screening for HIV and initiating prompt treatment for patients who test positive is the first step toward reducing cancer risk in people living with HIV, Drs Wilkinson and McCrea said. Vaccinations for viruses like HPV and hepatitis B can provide additional protection.
People living with HIV may face structural barriers to completing regular cancer screenings, and the emotional toll of managing their stigmatized condition may complicate this further.10
We know that individuals who have HIV have poorer outcomes with cancers, higher rates of cancers, they are more likely to present abnormally, and they are more likely to progress quicker.
To address these barriers, Dr Wilkinson emphasizes that “shared decision-making is important. Showing up with empathy is important. Meeting patients where they are and understanding why that is where they are.”
Effective communication, both with patients and appropriate specialists, will help primary care providers play their part in preventing cancer in people living with HIV, Drs Wilkinson and McCrea concluded.
“It’s prioritizing needs while also continuing to partner with the patient to help them make the best choices, but also honoring where they are and respecting where they are while we are educating them and advocating for them,” Dr Wilkinson said.
This article originally appeared on Clinical Advisor
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