Cumulative Incidence of Cancer Among Persons With HIV in North America

Abstract

Background Cancer is increasingly common among HIV patients given improved survival. Objective To examine calendar trends in cumulative cancer incidence and hazard rate by HIV status. Design Cohort study Setting North American AIDS Cohort Collaboration on Research and Design during 1996–2009 Patients 86,620 HIV-infected and 196,987 uninfected adults Measurements We estimated cancer-type-specific cumulative incidence by age 75 years by HIV status and calendar era, and examined calendar trends in cumulative incidence and hazard rates. Results Cumulative incidences (%) of cancer by age 75 (HIV+/HIV−) were: Kaposi sarcoma (KS), 4.4/0.01; non-Hodgkin’s lymphoma (NHL), 4.5/0.7; lung, 3.4/2.8; anal, 1.5/0.1; colorectal, 1.0/1.5; liver, 1.1/0.4; Hodgkin lymphoma (HL), 0.9/0.1; melanoma, 0.5/0.6; and oral cavity/pharyngeal, 0.8/0.8. Among HIV-infected subjects, we observed decreasing calendar trends in cumulative incidence and hazard rate for KS and NHL. For anal, colorectal and liver cancers, increasing cumulative incidence, but not hazard rate trends, were due to the decreasing mortality rate trend (−9% per year), allowing greater opportunity to be diagnosed with these cancer types. Despite decreasing hazard rate trends for lung, HL, and melanoma, we did not observe cumulative incidence trends due to the compensating effect of the declining mortality rate on cumulative incidence. Limitations Secular trends in screening, smoking, and viral co-infections were not evaluated. Conclusions Our analytic approach helped disentangle the effects of improved survival and changing cancer-specific hazard rates on cumulative incidence trends among HIV patients. Cumulative cancer incidence by age 75, approximating lifetime risk in HIV patients, may have clinical utility in this population. The high cumulative incidences by age 75 for KS, NHL, and lung cancer supports early and sustained ART and smoking cessation. Primary Funding Source National Institutes of Health

Kaposi sarcoma–associated herpesvirus: immunobiology, oncogenesis, and therapy

“…Kaposi sarcoma (KS) is the most common cancer in individuals living with HIV/AIDS today (1,2). While the introduction of effective HIV therapy was concurrent with a decline in the incidence of KS in the United States, KS incidence has stabilized and remained essentially level since 2000.…”

Incidence of AIDS-Defining Opportunistic Infections in a Multicohort Analysis of HIV-infected Persons in the United States and Canada, 2000–2010

“…In this report, we focus on incident AIDS-defining infections in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD); rates of AIDS-defining malignancies have been described separately [28]. We sought to assess whether incidence rates of first OIs have continued to decline or have stabilized over the last decade among such HIV-infected patients in care and to describe risk factors for and the epidemiology of these OIs in the recent ART era.…”

Cancer screening in women living with HIV infection

“…As the frequency of classically defined AIDSdefining malignancies (ADM) such as Kaposi's sarcoma, primary central nervous system lymphoma and intermediate and high-grade peripheral B cell non-Hodgkin's lymphomas wane, other non-ADM loom large and now represent a substantial health risk to people living with HIV/AIDS (PLWHA). 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.…”