Cancer in People with Hemophilia and HIV Infection

By Dr. David Clark 

10/31/24 

A group in Japan looked at cancer in hemophilia patients infected with HIV, the AIDS virus.  In data from 64 HIV-treatment centers, they found 328 patients with both hemophilia and HIV infection of which 35 developed cancers over the 8-year study period.  The rationale for the study is that there had been no surveys of hemophilia/HIV patients during the time period since the development of antiretroviral therapy (ART) for HIV infection and direct-acting antivirals (DAAs) for hepatitis C.  The study did not include cancers that are a direct result of AIDS, such as Kaposi’s Sarcoma. 

The 35 patients (seven or 20% with hemophilia B) had a median age of 51.  Six percent reported heavy alcohol consumption and 18% were current smokers.  All but one were co-infected with hepatitis C.  The most common cancers were liver cancer (41% of patients) followed in order by colon cancer (14%), malignant lymphoma (9%), tongue cancer (6%) and papillary thyroid cancer (6%).   

Metastasis (spread of cancer to other tissues) had occurred in 29% of the patients.  After treatment 68% of the patients had complete remission, but 18% died. 

The results suggest that all forms of cancer are about twice as common in hemophilia patients infected with HIV than in the general population.  Liver cancer was about 23 times more common in these patients, possibly because of co-infection with hepatitis C, which is known to increase the risk.  Interestingly, the percentage of heavy drinkers was relatively low at 6%, so the incidence of liver cancer could be even higher in other cultures that tend to drink more heavily.  The incidence of colon cancer was only about 1.3 times that in the general population. 

Papillary thyroid cancer was found in two of the 35 patients (6%).  This is a fairly rare cancer, so finding it at all is surprising.  The reason is unknown.  The study also found that all of the cancers tended to occur in younger-than-expected patients.  The authors conclude: “These findings emphasize the importance of cancer screening and preventive measures even in younger [patients with hemophilia and HIV] because early detection is crucial for addressing the elevated risk.”  [Koga M et al., Glob Health Med, 6(5) 316-323, 2024]