Types of Cancer Among HIV-infected Persons
Types of Cancer Among HIV-infected Persons
Abstract & Commentary
By Dean L. Winslow, MD, FACP, FIDSA, Chief, Division of AIDS Medicine, Santa Clara Valley Medical Center; Clinical Professor, Stanford University School of Medicine, Section Editor, HIV, is Associate Editor for Infectious Disease Alert.
Synopsis: A total of 54,780 HIV-infected persons enrolled in two large cohort studies followed from 1992-2003, and 334,802 patients from 13 population-based cancer registries, were studied. Standardized rate ratios (SRRs) were used to compare cancer incidence in the HIV-infected population with cancer incidence in the general population. The following non-AIDS-defining cancers were seen with excess incidence in the HIV-infected population: anal, vaginal, Hodgkin's lymphoma, liver, lung, melanoma, oropharyngeal, leukemia, colorectal, and renal. The incidence of prostate cancer was lower among HIV-infected patients than in the general population.
Source: Patel P, et al. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992-2003. Ann Int Med. 2008;148:728-736.
Data on cancer incidence in the HIV-infected population were derived from the CDC-sponsored Adult and Adolescent Spectrum of HIV Disease Project (ASD) conducted in 11 geographic areas, as well as from the HIV Outpatient Study (HOPS) conducted in eight US cities. The Surveillance, Epidemiology, and End Results Program (SEER) is an active and passive cancer surveillance system which collects data from 13 population-based cancer registries in the United States. The SEER program includes HIV-infected patients who probably represent fewer than 1% of the total population studied.
Important longitudinal data from this study show some important trends, including the progressive reduction in incidence of AIDS-defining cancers from 1992-1995 until 2000-2003. Kaposi sarcoma fell from SRR 197.0 to 112.1, and non-Hodgkin's lymphoma fell from 79.4 to 17.0, although cervical cancer SRRs remained stable at 11.8 and 10.1 across these time periods.
In contrast, the incidence of most of the traditionally non-AIDS-defining cancers remained significantly elevated or increased over the time periods of the study. Anal cancer SRRs increased from 31.4 to 59.4, Hodgkin's lymphoma from 11.7 to 17.9, and melanoma from 1.3 to 3.0. The following non-AIDS-defining cancers were shown to be increased in incidence compared to the general population over time, but their incidence remained relatively stable: liver 9.3 and 7.0, lung 3.5 and 3.6, oropharyngeal 2.5 and 3.0, colorectal 2.5 and 2.4, and breast 0.7 and 1.1 during both time periods, respectively. The incidence of prostate cancer was less frequent in HIV patients vs the general population, with SRRs of 0.3 during 1992-1995 and 0.7 during 2000-2003.
Commentary
This study provides an important update to our understanding of cancer in HIV-infected patients. It highlights the importance of non-AIDS-defining cancers in HIV-infected patients, which in contrast to AIDS-defining cancers, have not been significantly reduced in frequency due to HAART. In particular, due to the fact that HAART does not alter the incidence or progression of either cervical cancer or anal neoplasia, efforts to detect and treat these HPV-related malignancies at earlier stages in HIV-related patients should continue. These data also reinforce the importance of tobacco cessation efforts and colorectal cancer screening in HIV-infected patients.
Data on cancer incidence in the HIV-infected population were derived from the CDC-sponsored Adult and Adolescent Spectrum of HIV Disease Project (ASD) conducted in 11 geographic areas, as well as from the HIV Outpatient Study (HOPS) conducted in eight US cities.Subscribe Now for Access
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