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Higher Non-AIDS Cancer Rate in Men With HIV: 30-Year MACS Study
  6th International Workshop on HIV and Aging
October 5-6, 2015, Washington, DC
Mark Mascolini
HIV-positive men had a higher incidence of both virus-related and virus-unrelated non-AIDS cancers than HIV-negative men in a 30-year Multicenter AIDS Cohort Study (MACS) analysis [1]. Since 2005, however, higher non-AIDS cancer incidence in HIV-positive men solely reflected a higher rate of virus-related cancers.
MACS investigators who ran this study noted that risk of some non-AIDS cancers rises with age, but whether HIV accelerates this heightened risk remains uncertain. They suggested four factors that may boost non-AIDS cancer risk in people with HIV--coinfection with cancer-causing viruses, HIV itself, chronic inflammation, and a weakened immune system. They conducted this study to compare non-AIDS cancer incidence in MACS men with versus without HIV and to repeat that comparison for virus-related cancers (HPV-related anal and oral cancers, HBV/HCV-related liver cancer, and Epstein-Barr virus-related Hodgkin lymphoma) and nonviral cancers. The researchers excluded squamous and basal cell skin cancers.
The analysis involved 7137 men who have sex with men (MSM) who enrolled in the MACS between 1984 and 2014. Researchers confirmed new cancer diagnoses (incidence) through medical records, autopsy reports, cancer registry matching, and death certificates. They used Poisson regression analysis to compare non-AIDS cancer incidence in HIV-positive and negative men.
Through 96,150 person-years of follow-up, the MACS team counted 327 new non-AIDS cancers for an overall incidence of 34 per 10,000 person-years. Incidence proved much higher for nonviral cancers (26.3 per 10,000 person-years) than for virus-related cancers (7.7 per 10,000 person-years).
Men with HIV had significantly higher incidence of virus-related non-AIDS cancers than men without HIV, both among men younger than 55 (incidence rate ratio [IRR] 7.2, 95% confidence interval [CI] 3.4 to 15.2) and men 55 or older (IRR 2.7, 95% CI 1.1 to 6.6). Younger and older men with HIV also had higher rates of nonviral cancers (IRR 1.8, 95% CI 1.3 to 2.6, for younger men; IRR 1.3, 95% CI 0.9 to 1.9, for older men).
In the most recent antiretroviral therapy era, 2005-2014, younger and older men with HIV had higher rates of virus-related cancer (IRR 7.4, 95% CI 1.7 to 32.2, for younger men; IRR 3.9, 95% CI 1.2 to 12.6, for older men). But incidence of nonviral non-AIDS cancers did not differ by HIV status in 2005-2014. Age 55 or older was associated with a 4- to 5-fold higher incidence of nonviral cancers regardless of whether men had HIV.
The researchers concluded that in the current antiretroviral era "the excess incidence of non-AIDS-defining cancers among HIV-infected MSM exists solely for cancers with a viral etiology." And for virus-related cancers, HIV has a smaller impact on risk in men 55 or older.
1. Seaberg EC, Breen E, D'Souza G, et al. Incidence of non-AIDS-defining cancers (NADCs) between 1984 and 2014 in the Multicenter AIDS Cohort Study (MACS) by HIV status and viral infection etiology. 6th International Workshop on HIV and Aging. October 5-6, 2015, Washington, DC. Abstract 12.