Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study

Abstract

BackgroundMonitoring cancer risk among HIV-infected people in the modern antiretroviral therapy (ART) era is critical given their elevated risk for many cancers and prolonged survival with immunosuppression, ART exposure, and aging. Our study described cancer risk in HIV-infected people in the United States relative to the general population.MethodsUtilizing data from linked population-based HIV and cancer registries (nine areas; 1996–2012), we calculated standardized incidence ratios (SIRs). We tested SIR differences by AIDS status and over time using Poisson regression.FindingsAmong 448,258 HIV-infected people, risk was elevated (p<0·0001) for cancer overall (SIR 1·69; 95%CI: 1·67–1·72), AIDS-defining cancers (Kaposi sarcoma [498; 478–519], non-Hodgkin lymphoma [11·5; 11·1–11·9], and cervix [3·24; 2·94–3·56]), most other virus-related cancers (e.g., anus [19·1; 18·1–20·0], liver [3·21; 3·02–3·41], and Hodgkin lymphoma [7·70; 7·20–8·23]), and some virus-unrelated cancers (e.g., lung [1·97; 1·89–2·05]), but not for other common cancers. Risk for several cancers was higher after AIDS onset and declined across calendar periods. After multivariable adjustment, SIRs decreased significantly across 1996–2012 for six cancers (Kaposi sarcoma, two non-Hodgkin lymphoma subtypes, anus, liver, and lung) but remained elevated in the latest period. SIRs did not increase over time for any cancer.InterpretationRisks for several virus-related cancers and lung cancer declined among HIV-infected people, likely reflecting ART expansion since 1996. Despite declines, risk for many cancers remain elevated in the modern treatment era.FundingNational Cancer Institute.

Risk of oral tongue cancer among immunocompromised transplant recipients and human immunodeficiency virus‐infected individuals in the United States

“…Our results suggest that in the time interval closest to cancer diagnosis, individuals with oral tongue, oropharyngeal, and other oral cavity SCCs were moderately immunosuppressed, whereas those with oral cavity/pharynx NHLs were severely immunosuppressed. Also, although it is known that HAART has significantly improved the immune status of patients with HIV/AIDS, compared with the general population, risks remain elevated for those who have cancers profoundly affected by immunosuppression (eg, Kaposi sarcoma and NHL) along with the risks of cancers modestly affected by immunosuppression (eg, anal cancer) . These observations indicate that HAART‐associated immune restoration is incomplete, at least as it pertains to the risk of certain cancers.…”

HIV-related Refractory Hodgkin Lymphoma: A Case Report of Complete Response to Nivolumab

“…2 While the distribution of histologic subtypes may have shifted slightly in the last 20 years with the widespread use of ART, 3 the overall incidence of HIV-HL has not significantly decreased, in contrast to dramatic decreases in the rates of Kaposi’s sarcoma, primary central nervous system lymphoma, and diffuse large B cell lymphoma, suggesting that ART-mediated immune reconstitution is not adequate to prevent Hodgkin lymphomagenesis in the HIV-infected population. 4 Additionally, the observation that EBV is invariably detectable in HIV-HL regardless of histology, 5-7 and only seen in 20-40% of cHL cases in the HIV-uninfected population, has sparked research interest in the tumor microenvironment of HIV-HL in search of the unique role of EBV in this disease. In the meantime, HIV-HL is treated under the same guidelines as cHL in the general population.…”

HIV‐1, HAART and cancer: A complex relationship

“…HAART contributed to a slight reduction in overall cancer rates in HIV‐infected people . Nevertheless, nowadays people living with HIV still have a 1.6–1.7‐fold greater overall risk of cancer development relative to the general population, and the risk is rising with age . This fact can be explained by predisposing factors such as immunosuppression combined with chronic inflammation due to virus persistence .…”

“…Both virus‐related and virus‐unrelated cancers contribute to this trend . NADCs represent approximately 2/3 of all cancers in HIV‐patients; they are two times more frequent than ADCs . The rise of NADCs in the HAART era is in part linked to the overall aging of people with HIV, this provides more time for cancer to evolve .…”

“…Interestingly, for some reasons, some cancers are significantly more rare in HIV‐infected patients compared to the general population . They include stomach, colorectal, kidney, uterus, prostate, breast, brain and thyroid cancers .…”