Study Finds Cancer Is Increasingly Common in Patients With HIV, Necessitating Targeted Cancer Prevention Efforts
The effectiveness of antiretroviral therapy in the treatment of patients with human immunodeficiency virus (HIV) has prolonged lives and resulted in cancer becoming increasingly common in this population, with a higher burden than the general population due to impaired immune function, including chronic inflammation, and a higher prevalence of risk factors, including smoking and viral co-infections, according to a study by Silverberg et al. Among people with HIV, the highest cumulative incidences of AIDS-defining cancer types were Kaposi sarcoma, non-Hodgkin lymphoma, and lung cancer. The incidence of several types of non–AIDS-defining cancer, including Hodgkin lymphoma and lung, anal, and oral cavity/pharyngeal cancers is also higher in people with HIV.
The study findings suggest that people with HIV may benefit from increased cancer screening and prevention efforts. The study is published in Annals of Internal Medicine.
Study Methodology
The primary objective of the study was to compare time trends in cumulative cancer incidence among people with and without HIV. The study included 86,620 people with HIV and 196,987 people without HIV. The study population consisted of adults, 18 years and older, followed between 1996 and 2009 in 16 cohorts from the United States and Canada participating in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) study.
Measurements for cancer type–specific cumulative incidence by age 75 and calendar trends in cumulative incidence and hazard rates, each by HIV status, were analyzed.
Study Results
Cumulative incidences of cancer by age 75 years for persons with and without HIV, respectively, were as follows: Kaposi sarcoma, 4.4% and 0.01%; non-Hodgkin lymphoma, 4.5% and 0.7%; lung cancer, 3.4% and 2.8%; anal cancer, 1.5% and 0.05%; colorectal cancer, 1.0% and 1.5%; liver cancer, 1.1% and 0.4%; Hodgkin lymphoma, 0.9% and 0.09%; melanoma, 0.5% and 0.6%; and oral cavity/pharyngeal cancer, 0.8% and 0.8%.
Among individuals with HIV, calendar trends in cumulative incidence and hazard rate decreased for Kaposi sarcoma and non-Hodgkin lymphoma. For anal, colorectal, and liver cancer, increasing cumulative incidence, but not hazard rate trends, were due to the decreasing mortality rate trend (–9% per year), allowing greater opportunity to be diagnosed. Despite decreasing hazard rate trends for lung cancer, Hodgkin lymphoma, and melanoma, cumulative incidence trends were not seen because of the compensating effect of the declining mortality rate.
“The high cumulative incidences by age 75 years for Kaposi sarcoma, non-Hodgkin lymphoma, and lung cancer indicate that public health efforts need to be intensified to promote early, sustained antiretroviral therapy; smoking cessation; and lung cancer screening. As the population with HIV ages, future estimates of cumulative incidence could be stratified by levels of cancer risk factors, such as CD4+ count, smoking, alcohol consumption, and hepatitis B virus or hepatitis C virus infection, to more accurately inform patients and providers about risk and to help further target prevention efforts,” concluded the study authors.
Michael J. Silverberg, PhD, MPH, of Kaiser Permanente, is the corresponding author for the Annals of Internal Medicine article. Dr. Silverberg and Bryan Lau, PhD, MHS, of Johns Hopkins Bloomberg School of Public Health, contributed equally to this work.
Funding for this study was provided by the National Institutes of Health; the Centers for Disease Control and Prevention; Health Resources and Services Administration; Canadian Institutes of Health Research; Canadian Institutes of Health Research New Investigator Award; Ontario Ministry of Health and Long-Term Care; and the government of Alberta, Canada. To view study authors’ conflicts of interest information, go to acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2768.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
