Cancer risk in people infected with human immunodeficiency virus in the United States

Engels, Eric A.; Biggar, Robert J.; Hall, H. Irene; Cross, Helene; Crutchfield, Allison; Finch, Jack L.; Grigg, Rebecca; Hylton, Tara; Pawlish, Karen; McNeel, Timothy S.; Goedert, James J.

doi:10.1002/ijc.23487

Cited by 675 publications

(602 citation statements)

References 36 publications

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“…The incidence of this lymphoma increased substantially following an AIDS diagnosis but also, somehow paradoxically, rose over time in association with the introduction of cART. Furthermore, the authors of the study conclude that, among people with this syndrome, the relationship between risk for neoplastic transformation and CD4 count is nonlinear [14].…”

Section: Epidemiologymentioning

confidence: 97%

“…Nevertheless persons only marginally immunosuppressed may still be at excess risk of developing associated malignancies especially with extended survival. A recent study highlights the complex correlation altered immunity and cART in the face of HL [14]. The incidence of this lymphoma increased substantially following an AIDS diagnosis but also, somehow paradoxically, rose over time in association with the introduction of cART.…”

Section: Epidemiologymentioning

confidence: 99%

“…An increasing number of other neoplastic disorders including HL, testicular seminoma and lung cancer are still described as non-AIDS defining [12], [13] and [14]. Of note is a long-running Swiss study showing no increase in this particular lymphoma in recent years and also not among persons infected with the human immunodeficiency virus [15].…”

Section: Introductionmentioning

confidence: 99%

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Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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Presentation of Hodgkin lymphoma (HL) is distinctive in the infected individual being more advanced, accompanied by B symptoms and the presence of extranodal disease particularly lymphadenopathy of the head and neck. Bone marrow involvement may be found in over 50% of cases. Virtually all co express gamma-herpesvirus. Phenotypically there is prominence of the mixed-cellularity and lymphocyte depleted histopathologic subtypes that define an aggressive clinical course in comparison to other variants. Prior to the induction of cART, median survival was only 1-2 years. Notably the first chemotherapy trial using ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in 21 patients, without treating the viral infection, resulted in a 43% complete remission rate accompanied by severe haematological toxicities but did not extend median survival with this being 1.5 years matching the negative cases.Significant change accompanied concomitant anti-retroviral therapy that could be given safely even with dose intensive regimens exemplified by BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) in 12 patients or the Stanford V regimen (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone) coupled with involved-field radiation for bulky disease studied in 59 patients. BEACOPP extended overall survival (OS) to 83% at 2 years. A similar trend was seen 1 when using the Stanford V regimen with an OS rate of 51% at 3 years, disease-free survival (DFS) of 68% and freedom from progression (FFP) in 60%. Additional benefits accrued from supportive care with stimulatory peptides such as G-CSF and when combined with bacterial prophylaxis results approached that found in the uninfected reference group. Current consensus holds this particular lymphoma as still among the non-AIDS defining cancers being lung, stomach, liver or anal despite these having recently gained more attention as several of these neoplasms may be occurring more commonly in the era of cART.While the relative risk of developing a non-AIDS-defining neoplasm in HIV-infected persons on the average is 2-3 times, the risk for developing HL in HIV-infected cases impressively ranges between 5 and 25 times when compared to the general population. Based on the precedent in which Kaposi sarcoma and the non-Hodgkin lymphomas distinctively alter the course of this retroviral infection in a way indistinguishable from concurrent Hodgkin lymphoma we propose that this entity be similarly regarded and the hypothesis tested in large randomised prospective study.

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Section: Epidemiologymentioning

confidence: 97%

Section: Epidemiologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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“…Furthermore, HAART has been demonstrated to reduce the incidence of Kaposi sarcoma and non-Hodgkin lymphoma. 40 The effect of HAART on the incidence or progression of PCa is not yet known. Viral infections have been implicated in the development of several malignancies including PCa.…”

Section: Highly Active Antiretroviral Therapymentioning

confidence: 99%

HIV and prostate cancer: a systematic review of the literature

Silberstein

Downs

Lakin

et al. 2008

Prostate Cancer Prostatic Dis

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Malignancy occurs with increased frequency in the HIV-positive population. The true incidence of prostate cancer in this population is unknown. In the few cases that have been presented in the literature, prostate cancer in HIV-positive men appears to behave much like it does in HIV-negative men. Prostate cancer is the most common malignancy in men and the second leading cause of cancer death. Approximately 800 000 men in the United States are HIV positive, and innovative therapies have dramatically improved survival. HIV disproportionately impacts ethnic groups with increased risk of prostate cancer and has been associated with increases in the incidence of certain malignancies. Despite the high prevalence of both diseases, there is relatively little literature about prostate cancer in HIV-positive patients. There is no consensus on how to screen or treat this patient population. We review the literature with regards to incidence, screening, treatment, and outcomes of this poorly characterized population. We briefly discuss the impact of highly active antiretroviral therapy and testosterone supplementation in the development of prostate cancer. A systematic review of the literature was conducted using MEDLINE key words 'HIV,' 'prostate,' 'prostate cancer' and 'AIDS.' Manual bibliographic review of cross-referenced items was also performed. A total of 176 unique abstracts and publications were reviewed; many authors provided data on the incidence of HIV and various malignancies including prostate cancer. Twelve unique publications providing detailed information on 60 patients with HIV and prostate cancer were identified. Prostate cancer is a common malignancy in HIV-positive men. With improved therapies for HIV and increasing survival, the importance for screening and treating prostate cancer is increasing. Acute outcomes of treatment do not demonstrate increased acute morbidity; however long-term outcomes have not been reported.

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“…[3][4][5] Many non-AIDS defining malignancies have been found at a higher incidence in HIV patients than in the general population. 6,7 The incidences of Hodgkin lymphoma (HL) and malignancy of liver, lung, anus, and oral cavity/pharynx have all been found to be higher among the HIV-infected population than the general population, 8,9 as well as melanoma, leukemia, and vaginal, colon, rectal, and kidney cancer in some studies. 8 Several oncogenic viruses are thought to cause AIDS-defining malignancies; human herpesvirus 8 is associated with KS, Epstein-Barr virus (EBV) is associated with the 2 most common NHL subtypes, and the human papillomavirus (HPV) is associated with cervical cancer.…”

mentioning

confidence: 99%

Relationship between current level of immunodeficiency and non‐acquired immunodeficiency syndrome‐defining malignancies

Reekie

Kósa

Engsig

et al. 2010

Cancer

129

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BACKGROUND:In the combined antiretroviral therapy (cART) era, non-acquired immunodeficiency syndrome (AIDS)-defining malignancies account for more morbidity and mortality in human immunodeficiency virus-infected patients than AIDS-defining malignancies. However, conflicting data have been reported on the relationship between immunodeficiency and the development of some non-AIDS-defining malignancies. METHODS: A total of 14,453 patients from the prospective, multinational EuroSIDA cohort were included. Malignancies were classified as virusrelated, non-virus-related epithelial, and other. The incidence of non-AIDS-defining malignancies was calculated stratified by current CD4 count. Poisson regression was used to investigate factors associated with the development of non-AIDS-defining malignancies. RESULTS: A total of 356 non-AIDS-defining malignancies occurred, with an incidence rate of 4.3 per 1000 person years of follow-up (95% confidence interval [CI], 3.8-4.7); 172 (48.3%) were virusrelated, 135 (37.9%) were non-virus-related epithelial, and 49 (13.7%) were classified as other. Anal (69 cases), lung (31 cases), and melanoma (13 cases), respectively, were the most common non-AIDS-defining malignancies within each group. After adjustment, current CD4 was associated with virus-related non-AIDS-defining malignancies (incidence rate ratio [IRR], 0.81 per doubling; 95% CI, 0.75-0.88; P < .0001) and non-virus-related epithelial non-AIDSdefining malignancies (IRR, 0.84; 95% CI, 0.75-0.95; P ¼ .004), but not with other non-AIDS-defining malignancies (IRR, 1.04; 95% CI, 0.83-1.31; P ¼ .73). Current CD4 count was also associated with anal cancer (IRR, 0.86; 95% CI, 0.75-0.99; P ¼ .03), Hodgkin lymphoma (n ¼ 52; IRR, 0.83; 95% CI, 0.73-0.95; P ¼ .005), and lung cancer (IRR, 0.76; 95% CI, 0.64-0.90; P ¼ .0002). CONCLUSIONS: A low current CD4 count was associated with an increased incidence of certain non-AIDS-defining malignancies. Starting cART earlier to reduce the proportion of patients with a low CD4 count may decrease the rate of developing many common non-AIDS-related malignancies. A randomized trial to explore this strategy is urgently needed. Cancer 2010;116:5306-15.

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Cancer risk in people infected with human immunodeficiency virus in the United States

Cited by 675 publications

References 36 publications

Human immunodeficiency and Hodgkin lymphoma

Human immunodeficiency and Hodgkin lymphoma

HIV and prostate cancer: a systematic review of the literature

Relationship between current level of immunodeficiency and non‐acquired immunodeficiency syndrome‐defining malignancies

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