HIV This Week

Patel P, Hanson DL, Sullivan PS, Novak RM, Moorman AC, Tong TC, Holmberg SD, Brooks JT; Adult and Adolescent Spectrum of Disease Project and HIV Outpatient Study Investigators. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992-2003. Ann Intern Med. 2008;148(10):728-36.

Persons who are HIV-infected may be at higher risk for certain types of cancer than the general population. Patel and colleagues conducted prospective observational cohort studies in the United States to compare cancer incidence among HIV-infected persons with incidence in the general population from 1992 to 2003. 54,780 HIV-infected persons in the Adult and Adolescent Spectrum of HIV Disease Project (47,832 patients) and the HIV Outpatient Study (6948 patients), who contributed 157,819 person-years of follow-up from 1992 to 2003, and 334,802,121 records from the Surveillance, Epidemiology, and End Results program of 13 geographically defined, population-based, central cancer registries were included. Standardized rate ratios were estimated to compare cancer incidence in the HIV-infected population with standardized cancer incidence in the general population. The incidence of the following types of non-AIDS-defining cancer was significantly higher in the HIV-infected population than in the general population: anal (standardized rate ratio, 42.9 [95% CI, 34.1 to 53.3]), vaginal (21.0 [CI, 11.2 to 35.9]), Hodgkin lymphoma (14.7 [CI, 11.6 to 18.2]), liver (7.7 [CI, 5.7 to 10.1]), lung (3.3 [CI, 2.8 to 3.9]), melanoma (2.6 [CI, 1.9 to 3.6]), oropharyngeal (2.6 [CI, 1.9 to 3.4]), leukaemia (2.5 [CI, 1.6 to 3.8]), colorectal (2.3 [CI, 1.8 to 2.9]), and renal (1.8 [CI, 1.1 to 2.7]). The incidence of prostate cancer was significantly lower among HIV-infected persons than the general population (standardized rate ratio, 0.6 [CI, 0.4 to 0.8]). Only the relative incidence of anal cancer increased over time. A study limitation was the lower ascertainment of cancer in the HIV cohorts which may result in a potential bias to underestimate rate disparities. Tobacco use as a risk factor and the effect of changes in cancer screening practices could not be evaluated. In conclusion, the incidence of many types of non-AIDS-defining cancer was higher among HIV-infected persons than among the general population from 1992 to 2003.

Editors´note: In addition to the significantly higher incidence of several types of cancer in people living with HIV compared to the general population, this study found increasing incidence rates over time for melanoma; Hodgkin lymphoma; and colorectal, anal, and prostate cancer, despite the advent of antiretroviral treatment. Both behavioural/lifestyle factors and other viruses (human papilloma virus, Epstein Barr Virus) may be implicated. In the case of HPV infection, prevention includes screening for early detection and treatment, along with evaluation of primary prevention measures such as vaccination and male circumcision.