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Cancer Stage, Age at Diagnosis and Survival Comparing HIV(+) and HIV(-) Individuals with Common Non-AIDS-Defining Cancers
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Reported by Jules Levin
CROI 2012
Michael J. Silverberg1, Chun R. Chao2, Wendy Leyden1, Lanfang Xu2, Jeanette C. Yu1, Michael A. Horberg3, Daniel Klein4, William J. Towner5, Charles P. Quesenberry, Jr.1, Donald I. Abrams6,7
1Kaiser Permanente Northern California (KPNC), Oakland, CA; 2Kaiser Permanente Southern California (KPSC), Pasadena, CA; 3Mid-Atlantic Permanente Research Institute, Rockville, MD; 4KPNC, Hayward, CA; 5KPSC, Los Angeles, CA;
6San Francisco General Hospital, San Francisco, CA; 7University of California at San Francisco, San Francisco, CA, USA
Cancer Stage, Age at Diagnosis, and Survival Comparing HIV+ and HIV- Individuals with Common Non-AIDS-defining Cancers
Michael Silverberg1, C Chao2, W Leyden1, L Xu2, J Yu1, M Horberg3, D Klein4, W Towner5, C Quesenberry1, and D Abrams6,7
1Kaiser Permanente Northern California, Oakland, US; 2Kaiser Permanente Southern California, Pasadena, US; 3Mid-Atlantic Permanente Res Inst, Rockville, MD, US; 4Kaiser Permanente Northern California, Hayward, US; 5Kaiser Permanente Southern California, Los Angeles, US; 6San Francisco Gen Hosp, CA, US; and 7Univ of California, San Francisco, US
Background: HIV+ individuals have an increased risk for several non-AIDS-defining cancers (NADC). However, conflicting data exist regarding differences in age at diagnosis, cancer stage at diagnosis, and survival between HIV+ and HIV- individuals with NADC.
Methods: We identified 22,081 HIV+ and 230,069 age- and sex-matched HIV- individuals between 1996 and 2009 who were enrolled in Kaiser Permanente (KP) California. Incident cancers and TNM stage were ascertained from SEER-contributing KP cancer registries. Analyses considered prostate, anal, lung, and colorectal cancer, 4 common NADC diagnosed among KP HIV+ individuals. Deaths were ascertained from membership files, California death certificates, and Social Security Administration datasets. We assessed by Kaplan-Meier the 5-year overall mortality by HIV status. Adjusted hazard ratios (aHR) for death by HIV status were obtained from Cox models adjusting for age, race/ethnicity, sex, TNM stage, and smoking (lung cancer only). Analyses also considered survival differences by HIV infection status for localized cancer (i.e., excluding metastatic Stage 4).
Results: HIV+ individuals had a younger age at diagnosis for anal, lung and colorectal, but not prostate cancer. Stage at diagnosis was similar by HIV status for all cancer types (p >0.05); however, there was a non-significant trend for more advanced stage at diagnosis for HIV+ compared with HIV- individuals for anal (stage 3 or 4: 39% vs. 16%) and lung cancer (stage 4: 64% vs 51%). For HIV+ individuals with prostate cancer, 5-year survival was lower (84% vs 91%, p = 0.038) and lung cancer (8% vs 22%, p <0.001). Adjusted HR confirmed the higher risk of death for HIV+ individuals with these cancers. In analyses that excluded metastatic cancers, the HR for HIV status remained significant for lung cancer with an HR of 2.0 (95%CI 1.3 to 3.1, p = 0.002), but not prostate cancer with an HR of 1.8 (95%CI 0.7 to 4.6, p = 0.25).
Conclusions: HIV+ individuals had an earlier mean age at diagnosis, but similar stage at diagnosis for several common NADC, compared with HIV- individuals. HIV+ individuals had reduced survival for prostate and lung cancer, but not anal and colorectal cancer. Limitations of the study include the small number of cases, and the analysis of overall, but not cause-specific mortality; thus, confirmation of our findings are needed. Improved primary and secondary lung cancer prevention is essential given the poor survival.
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