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A Seven-Year Review of AIDS and Non-AIDS related Malignancies in a Large HIV/AIDS Center in New York
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Reported by Jules Levin
IDSA Oct 20-23 2011 Boston, MA
V. K. Pokuri 1, C. Albany 1, G. Psevdos1,2, J. Paredes1,2, V. Sharp1,2
1. St Luke's Roosevelt Medical Center, 2. Center for Comprehensive Care
ABSTRACT
Background: Due to the advent of potent antiretroviral therapy (HAART) and increased longevity of HIV-infected patients, malignancies are being diagnosed frequently with an increasing number attributed to non-AIDS-defining cancers.
Methods: A retrospective chart review of 4874 adult HIV-infected patients from 1/1/2003 to 12/31/2009 was performed. 239 patients were diagnosed with neoplastic diseases. Demographical and HIV related data, viral hepatitis serologies, histopathology, tobacco history and treatment outcomes were analyzed.
Results:
The incidence of malignancies was 239/4874, 4.9%.
Characteristics of the cohort: mean age 49 (range 21-77), 78 % were male, 48 % Black, 25 % White and 27 % Latino. Risk factors for HIV: 45 % MSM, 25 % IVDU, 29 % heterosexual, 1 % perinatal.
53 % had used tobacco, 28 % had Hepatitis C and 14 % had Hepatitis B co-infections.
At cancer diagnosis the mean CD4 T-cell count was 229/μL (range 2-1011), median CD4 of 186/μL; mean HIV viral load log10 4.69; median log10 2.83.
The mean CD4 T-cell in AIDS defining tumors vs. non AIDS, 170 vs. 291, P: 0.0003. 73 % were on HAART. 51 % of patients died from cancer.
93 of 239 (39%) malignancies were AIDS- related: non-Hodgkin's Lymphoma-60/93; Kaposi's sarcoma-32; 1cervical cancer.
146 of 239 (61 %) were non-AIDS related: Lung-28/146 (adenocarcinoma 13, squamous cell 13, small cell 2); Prostate adenocarcinoma-20; Hodgkin's Lymphoma-15; Anorectal-13 (squamous cell 11, adenocarcinoma 2); liver cancer-8.
Other non-AIDS related malignancies noted were Gastrointestinal-22 (colon 6, pancreas 5, tongue 4, stomach 2, biliary tract 2, esophagus 1, klatskin tumor 1, tonsil 1); Genitourinary-14 (kidney 3, vulva 2, scrotum 2, testis 2, ovary 2, vagina 1, penis 1, urethra 1); Nervous system-astrocytoma 1; Hematologic-7 (leukemia 3, multiple myeloma 2, plasmacytoma 2); Breast-6; Unknown primary-6; Skin-4; Thyroid-2.
Conclusion: A higher rate of non-AIDS related cancers was recognized, with lung and prostate tumors the most frequently observed. Cancer prevention, age-appropriate screening, and promotion of risk-reduction behaviors (e.g. tobacco cessation) need to be implemented to facilitate earlier disease recognition and optimal treatment strategies as patients with HIV live longer.
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