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Hodgkin Lymphoma, Liver Cancer, Anal Cancer More Common With HIV
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12th European AIDS Conference, November 11-13, 2009, Cologne, Germany
Mark Mascolini
Compared with the general population, HIV-infected people in Belgium had more than 10-fold higher rates of anal cancer, Hodgkin lymphoma, and liver cancer [1]. But breast cancer incidence was lower in women with HIV than in those without HIV.
Understanding the risks and outcomes of non-AIDS cancers has gained urgency with growing awareness that these malignancies pose grave risks of morbidity and mortality in people with HIV [2,3]. This prospective cohort study at Saint-Pierre University in Brussels amassed 12,746 patient-years of follow-up on HIV-infected people from January 2002 through March 2009. The researchers compared new non-AIDS cancer diagnoses (incidence) in HIV-infected people with incidence in the general population by using standardized incidence ratios based on 2005 Belgian Cancer Registry data.
Clinicians diagnosed 45 non-AIDS cancers during the study period for an overall prevalence of 1.4% in people with HIV. Several factors distinguished HIV-infected patients with a new non-AIDS cancer from HIV-infected people without such cancers:
· Older age: 47 versus 38 years, P < 0.0001
· Longer duration of HIV infection: 59 versus 39 months, P = 0.0174
· Higher HCV rate: 22.2l% versus 10%, P = 0.0149
· Lower nadir CD4 count: 110 versus 224, P < 0.0001
· Higher rate of previous AIDS diagnoses: 33% versus 20%, P = 0.0455
Low nadir CD4 count correlated with non-AIDS cancer incidence in some earlier studies [4], but not in others [5]. Multivariate analysis determined that a higher nadir CD4 count lowered the risk of non-AIDS cancer (odds ratio [OR] 0.995, 95% confidence interval [CI] 0.992 to 0.998), while older age raised the risk (OR 1.07, 95% CI 1.04 to 1.1). A non-AIDS cancer diagnosis independently quadrupled the risk of death (hazard ratio 4.0, 95% CI 2.36 to 6.78).
Standardized incidence ratios (SIR) were substantially higher for three non-AIDS cancers when the investigators compared HIV-infected people with the general population:
· Anal cancer: SIR 46.01, 95% CI 16.80 to 100.16
· Hodgkin lymphoma: SIR 17.76, 95% CI 6.49 to 38.67
· Liver cancer: SIR 10.64, 95% CI 2.86 to 27.23
In contrast, breast cancer was about 70% less frequent in women with HIV than in HIV-negative women: SIR 0.31, 95% CI 0.06 to 0.91.
In a landmark meta-analysis of 7 cancer studies in people with HIV, the standardized incidence ratio compared with the general population was 11.03 (95% CI 8.48 to 14.4) for Hodgkin lymphoma, 5.22 (95% CI 3.32 to 8.20) for liver cancer, and 1.90 (95% CI 1.53 to 2.36) for stomach cancer [6]. This study also found higher non-AIDS cancer rates in people immunosuppressed because of solid organ transplantation. Similarly increased risks in transplant patients with people with HIV suggested to the investigators "that it is immune deficiency, rather than other risk factors for cancer, that is responsible for the increased risk."
References
1. Dauby N, De Wit S, Delforge M, Necsoi VC, Clumeck N. Characteristics of non-AIDS-defining malignancies in the HAART era: a clinico-epidemiologic study. 12th European AIDS Conference. November 11-13, 2009. Cologne, Germany. Abstract PS3/2.
2. Grulich AE. Cancer: the effects of HIV and antiretroviral therapy, and implications for early antiretroviral therapy initiation. Curr Opin HIV AIDS. 2009;4:183-187.
3. Stebbing J, Duru O, Bower M. Non-AIDS-defining cancers. Curr Opin Infect Dis. 2009;22:7-10.
4. Powles T, Robinson D, Stebbing J, et al. Highly active antiretroviral therapy and the incidence of non-AIDS-defining cancers in people with HIV infection. J Clin Oncol. 2009;27:884-890.
5. Burgi A, Brodine S, Wegner S, et al. Incidence and risk factors for the occurrence of non-AIDS-defining cancers among human immunodeficiency virus-infected individuals. Cancer. 2005;104:1505-1511.
6. Grulich AE, van Leeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007;370:59-67.
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