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CDC Study Confirms Rising Non-AIDS Cancer Rate in With HIV
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XVIII International AIDS Conference, July 18-23, 2010, Vienna
Mark Mascolini
While numbers of AIDS-defining cancers fell among US residents with AIDS from 1991 through 2005, non-AIDS cancer numbers rose, particularly anal cancer and prostate cancer [1]. By definition, only non-AIDS cancers account for the rising cancer burden in US residents with HIV but without AIDS. Centers for Disease Control (CDC) investigators attributed the spike in non-AIDS cancers to the aging US AIDS population and to longer survival of people with HIV/AIDS because of improving antiretroviral regimens..
CDC researchers tracked cancer rates for people with AIDS from 1991 through 2005 and for people with HIV but not AIDS from 2004 through 2007. For the AIDS group they estimated cancer counts by applying cancer incidence rates to the US AIDS population by year, age, gender, race/ethnicity, HIV transmission group, and time since AIDS diagnosis. For the HIV group the CDC team estimated cancer counts by applying overall cancer rates for 1998-2007 to HIV data from 34 states that had confidential name-based HIV reporting since 2004.
The number of US residents with AIDS rose from 93,802 in 1991 to 399,762 in 2005. In that time, the proportion of AIDS patients 50 and older more than tripled, from 8% in 1991 to 29% in 2005. From 1991 through 2005, the investigators counted 76,558 AIDS cancer diagnoses in the US AIDS population. Among people with AIDS, AIDS-defining cancers declined from a peak of 7284 in 1993 to 1736 in 2005. Falling rates of Kaposi sarcoma and non-Hodgkin lymphoma--especially in the 30-to-39-year-old bracket--accounted for most of this drop.
Among people with AIDS, numbers of non-AIDS cancers jumped from 416 in 1991 to 2437 in 2005, an increase marked by steep upswings in anal cancer (18 in 1991 to 358 in 2005) and prostate cancer (10 in 1991 to 123 in 2005). Lung cancer diagnoses rose more slowly (from 112 in 1991 to 478 in 2005), as did numbers of Hodgkin lymphoma (from 72 in 1991 to 169 in 2005). Almost all of the gains in non-AIDS cancers among people with AIDS occurred in those over 39 years old.
From 2004 through 2007, the CDC researchers counted 2191 cancers in people with HIV but not AIDS in 34 states, including 454 lung cancers (21%), 166 breast cancers (8%), 154 anal cancers (7%), 150 Hodgkin lymphomas (7%), 147 prostate cancers (7%), 135 colorectal cancers (6%), and 103 oropharyngeal cancers (5%). All of these malignancies are non-AIDS cancers.
Combining the AIDS and HIV-only groups, the CDC team tallied 15,885 cancers in 34 states from 2004 through 2007, including 7869 AIDS cancers in people with AIDS (50%), 5372 non-AIDS cancers in people with AIDS (34%), 2191 non-AIDS cancers in AIDS-free people with HIV (14%), and 453 poorly specified malignancies.
The CDC suggested three factors accounting for the changing cancer burden in US residents with HIV and AIDS:
1. Availability of HAART since 1996, which has improved immunity (but not to normal) and prolonged survival
2. A growing number of HIV-infected people because people are living longer with HIV and not progressing to AIDS and people are living longer after an AIDS diagnosis.
3. Aging of the HIV/AIDS population, which will continue
The researchers concluded that the burden of non-AIDS cancers is rising sharply in the United States and that numbers of non-AIDS cancers are now equivalent to numbers of AIDS cancers. They predicted that the non-AIDS cancer burden will grow in coming years.
Reference
1. Shiels M, Pfeiffer R, Gail M, et al. The burden of cancer among HIV-infected persons in the U.S. population. XVIII International AIDS Conference. July 18-23, 2010. Vienna. Abstract WEAB0101.
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