Age at Cancer Diagnosis Among Persons With AIDS in the United States

Abstract

Background Studies have reported young ages at cancer diagnosis in HIV-infected people, suggesting that HIV accelerates carcinogenesis. However, these comparisons did not account for differences in population age structures. Objective To compare ages at diagnosis for non-AIDS-defining cancers arising in the AIDS and general populations, after adjusting for differences between these populations in age and other demographic characteristics. Design Registry linkage study Setting 15 U.S. HIV/AIDS and cancer registry databases. Participants People with AIDS in the HIV/AIDS Cancer Match Study (N=212,055, 1996–2007). Measurements We compared the age-at-diagnosis distributions of cancers in the AIDS and general populations, after adjusting for age and other demographics. Results The proportion of person-time contributed by older persons (65+ years) was far smaller in the AIDS (1.5%) than the general population (12.5%). Reflecting this difference, the ages at diagnosis for most cancers were ~20 years younger among people with AIDS. However, after adjustment for differences in the populations at risk, the ages at diagnosis in the AIDS and general populations did not differ for most cancers (e.g., no difference in the median ages of colon, prostate or breast cancers; all p>0.1). In contrast, ages at lung (median 50 vs. 54 years) and anal cancer (42 vs. 45 years) were significantly younger in people with AIDS than expected in the general population (p<0.001), and the age at Hodgkin lymphoma was significantly older (42 vs. 40 years, p<0.001). Limitations We lacked information on other cancer risk factors, including cigarette smoking. Further, our analysis was restricted to non-Hispanic whites and non-Hispanic blacks who had AIDS, perhaps limiting the generalizability of our findings to other racial and ethnic groups and to people with HIV, but without AIDS. Conclusions For most cancers, the age of diagnosis is similar in the AIDS and general populations, after accounting for the ages of the populations at risk. Modest age differences remained for a few cancers, perhaps reflecting acceleration of carcinogenesis by HIV or earlier exposure to cancer risk factors.

Cancer screening in women living with HIV infection

“…43 In contrast, a registry linkage study showed that the age of CRC was no different in groups infected with HIV and the general population. 3 The USPSTF recommends CRC screening with intervals between screening studies depending on the modality used for cancer detection (Table 2). 44 These include high-sensitivity fecal occult blood testing (FOBT) annually, sigmoidoscopy every 5 years with FOBT every 3 years, or colonoscopy every 10 years in adults who are deemed at average risk for CRC beginning at age of 50 years and continuing until age of 75 years.…”

“…2 Non-ADM in PLWHA are often typified by earlier age at onset, more aggressive clinical course and more advanced stage at presentation. 3,4 For many of these tumors, such as lung cancer and other aero-digestive tumors, the occurrence of cancer is linked to lifestyle choices, including tobacco use and alcohol consumption. 5 Co-infection with other viruses including hepatitis B virus (HBV), hepatitis C virus (HCV), and human papillomavirus (HPV) results in additive risks for liver cancer and squamous neoplasms of the head and neck, anus, and cervix.…”

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Older Adults

“…29 Some cancers (mainly anal cancer, liver cancer and Hodgkin's lymphoma) occur at younger ages in those infected with HIV compared to those without HIV. 30 Osteoporosis and fragility-related fractures occur more often in HIV-infected persons.…”

Lung Cancer in HIV Infection

“…17 Since then, a number of studies carried out either exclusively before the HAART era or both before and during the HAART era have suggested that lung cancer risk is greater among HIV-infected individuals compared to the general population (Table 1). 11,12,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Though some of the largest studies included only patients with an AIDS-defining diagnosis 11,18,21,22 several cohort and registry linkage studies, which have included HIV-positive patients with and without AIDS, have also consistently demonstrated an increased risk of lung cancer. 19,23,27,[28][29][30]33 In a meta-analysis of seven reports of HIV-associated cancer risk and published between 2002 and 2006, 444,172 people with HIV/AIDS were identified, of whom 1,297 were diagnosed with lung cancer.…”

“…40,[52][53][54][55][56][57][58][59][60][61][62] Yet, in a recent registry linkage study, the difference in the age at diagnosis of lung cancer was relatively modest between persons with AIDS and the general population (50 vs. 54 years) after adjusting for the underlying population structures. 31 In HIV-infected patients with lung cancer, men are significantly overrepresented compared to women, with a male-female sex ratio of 5-10:1. This likely reflects the epidemiology of lung cancer, as well as HIV/AIDS; in developing countries, both diseases affect men disproportionately compared to women.…”