Cancer risk following lymphoid malignancies among HIV-infected people

Abstract

Objective(s): HIV-infected people have increased cancer risk. Lymphoma survivors have an increased risk of certain second primary cancers in the general population, but second cancer risk among HIV-infected people is poorly understood. Herein, we characterized the risk of cancers following lymphoid malignancies among HIV-infected people. Design: Population-based linkage of HIV and cancer registries. Methods: We used data from the US HIV/AIDS Cancer Match Study (1996–2015) and evaluated the risk of first nonlymphoid malignancy in Cox regression models, with first lymphoid malignancy diagnosis as a time-dependent variable. Results: Among 531 460 HIV-infected people included in our study, 6513 first lymphoid and 18 944 first nonlymphoid malignancies were diagnosed. Risk of nonlymphoid cancer following a lymphoid malignancy was increased overall [adjusted hazard ratio (aHR) = 2.7; 95% confidence interval (CI) = 2.3--3.2], and specifically for cancers of the oral cavity (aHR = 2.6; 95% CI = 1.2–5.5), colon (2.4; 1.1–5.0), rectum (3.6; 1.9–6.7), anus (3.6; 2.5–5.1), liver (2.0; 1.2–3.5), lung (1.6; 1.1–2.4), vagina/vulva (6.1; 2.3–16.3), and central nervous system (5.0; 1.6–15.6), Kaposi sarcoma (4.6; 3.4–6.2), and myeloid malignancies (9.7; 6.1–15.4). After additional adjustment for prior AIDS diagnosis and time since HIV diagnosis, aHRs were attenuated overall (aHR = 1.7; 95% CI = 1.5–2.0) and remained significant for cancers of the rectum, anus, and vagina/vulva, Kaposi sarcoma, and myeloid malignancies. Conclusion: HIV–infected people with lymphoid malignancies have an increased risk of subsequent non–lymphoid cancers. As risks remained significant after adjustment for time since HIV diagnosis and prior AIDS diagnosis, it suggests that immunosuppression may explain some, but not all, of these risks.

Prevalence and Spectrum of Second Primary Malignancies among People Living with HIV in the French Dat’AIDS Cohort

“…These results were consistent with previous studies that identified a higher risk of developing NHL after KS among PLWH than among the general U.S. population [ 23 , 25 ], and a higher risk of developing KS after an AIDS-defining lymphoid malignancy [ 24 ].…”

“…In women, breast cancer was the most common SPC after primary NHL, which was in agreement with data of Mahal et al [ 24 ]. Additionally, as observed in the general population of French women [ 26 ], breast cancer was also the most common SPC after a primary breast cancer.…”

“…In the general French population of cancer survivors, an excess risk of SPCs was identified after a first cancer of the head and neck, larynx, esophagus, bladder, lip, kidney, lung or chronic lymphatic leukemia in men, and after a first cancer of the larynx, head and neck, esophagus, vagina, vulva or acute myeloid leukemia in women [ 5 ]. Likewise, the spectrum of SPCs observed in our cohort also differed from that observed in the general French population [ 5 ], but it was consistent with the spectrum of primary cancers in the cohort, as reported [ 12 , 13 , 23 , 24 ].…”

Second Primary Cancers in People With HIV/AIDS: A National Data Linkage Study of Incidence and Risk Factors

“…Another recent registry-based linkage study that examined second cancers only after a lymphoid primary cancer in PLWHIV found an increase in the risk of nonlymphoid cancers. 33 This is consistent with our finding that EBV-related FPCs, most of which were non-Hodgkin lymphoma, were not associated with the increased incidence of an EBV-related SPC, but rather other SPCs dominated in this subset.…”

HIV-related non-Hodgkin lymphomas affecting the oral cavity: a clinicopathologic study of 11 cases

“…However, some human cancers are still frequently diagnosed in HIV-positive patients ( 5 ), and they are categorized into 2 different types: 1) non-AIDS-defining cancers, including Hodgkin lymphomas, which are associated with advanced age, smoking, race and low CD4+ count ( 6 ); and 2) AIDS-defining cancers, usually associated with oncogenic viruses ( 7 ). Regarding AIDS-defining cancers, previous studies indicate Kaposi’s sarcoma as the most prevalent neoplasm, followed by non-Hodgkin lymphomas ( 8 ).…”