Trimodal or bimodal age-specific incidence rates for Burkitt lymphoma (BL) were observed in the United States general population, but the role of immunosuppression could not be excluded. Incidence rates, rate ratios, and 95% confidence intervals for BL and other non-Hodgkin lymphoma (NHL), by age and CD4 lymphocyte count categories, were estimated using Poisson regression models using data from the United States HIV/AIDS Cancer Match study . BL incidence was 22 cases per 100 000 person-years and 586 for non-BL NHL. Adjusted BL incidence rate ratio among males was 1.6؋ that among females and among non-Hispanic blacks, 0.4؋ that among non-Hispanic whites, but unrelated to HIV-transmission category. Non-BL NHL incidence increased from childhood to adulthood; in contrast, 2 age-specific incidence peaks during the pediatric and adult/geriatric years were observed for BL. Non-BL NHL incidence rose steadily with decreasing CD4 lymphocyte counts; in contrast, BL incidence IntroductionBurkitt lymphoma (BL) is an aggressive B-cell non-Hodgkin lymphoma (NHL) with 3 clinical variants: endemic (eBL), sporadic (sBL), and acquired immunodeficiency-associated BL (aBL). 1 These clinical variants, which are defined in part by where they occur geographically, are histologically indistinguishable 1 and their etiology is incompletely understood. 2 eBL occurs in children mostly as extranodal jaw or orbital masses in equatorial Africa and Papua New Guinea. 3 sBL occurs anywhere in the world at any age mostly with abdominal or nodal involvement. [4][5] Immunodeficiencyassociated BL is diagnosed in people with HIV, 1 among whom it is often the first indication of AIDS onset at least in the West. Risk for both eBL and sBL appears to be highest at ages 5-9 years and sBL rates are also elevated at the oldest ages. 4,6 Because BL is a rapidly growing tumor, doubling its cell mass approximately every 1-2 days, 7 the interval from trigger to diagnosis may be relatively short, so study of age-specific risk may provide etiologic information.In an assessment of age-specific risk for BL in the United States, using data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program (1973-2005), 8 we observed 3 incidence peaks near ages 10, 40, and 70 years among males and 2 peaks near ages 10 and 70 years among females for both whites and blacks. However, the role of AIDS-related immunosuppression could not be excluded 9,10 because we were not able to separately analyze AIDS and non-AIDS BL. To address this limitation, we investigated age-specific BL incidence among persons with AIDS (PWA) in the United States Because age is a surrogate for cumulative exposure to deleterious infections a linear increase in risk for BL with age in PWA would suggest cumulative impact of deleterious infections given immunosuppression, whereas a nonlinear risk increase would suggest that age may be a surrogate for differences in the etiology or biology of BL diagnosed at different ages that occur independent of immunosuppression. 8 MethodsData...

Squamous cell carcinoma of the conjunctiva (SCCC) has been associated with HIV infection in equatorial Africa, but the evidence for association with HIV in developed countries, where SCCC is rarer, is controversial. We investigated the risk for SCCC and other eye cancers in the updated U.S. HIV/AIDS Cancer Match Registry Study. We calculated standardized incidence ratios (SIRs) to estimate excess risk for SCCC, primary ocular lymphoma, ocular Kaposi sarcoma (KS) and other eye tumors among 491, 048 adults (aged > 15 years or older) with HIV/AIDS diagnosed from 1980 to 2004. We calculated relative proportions (per 10 5) to gain insight into risk factors. We identified 73 eye cancers (15 SCCC, 35 primary ocular lymphoma, 17 ocular KS and 6 other). Overall SIRs were elevated for SCCC (SIR, 12.2, 95% CI 6.8-20.2), primary ocular lymphoma (21.7, 95% CI 15.1-30.2) and ocular KS (109, 95% CI 63.5-175). Risk for SCCC was elevated regardless of HIV acquisition category, CD4 lymphocyte count and time relative to AIDS-onset. Relative proportions of SCCC risk were highest with age ≥50 (8/10 5), Hispanic ethnicity (7/10 5) and residence in regions with high-solar ultraviolet radiation (10/ 10 5). We show significantly increased incidence of SCCC among persons with HIV/AIDS in the U.S. The associations with age and geography are in accord with etiological role for ultraviolet radiation in SCCC.

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