Elevated Cancer-Specific Mortality Among HIV-Infected Patients in the United States

Abstract

Purpose Despite advances in the treatment of HIV, HIV-infected people remain at increased risk for many cancers, and the number of non–AIDS-defining cancers is increasing with the aging of the HIV-infected population. No prior study has comprehensively evaluated the effect of HIV on cancer-specific mortality. Patients and Methods We identified cases of 14 common cancers occurring from 1996 to 2010 in six US states participating in a linkage of cancer and HIV/AIDS registries. We used Cox regression to examine the association between patient HIV status and death resulting from the presenting cancer (ascertained from death certificates), adjusting for age, sex, race/ethnicity, year of cancer diagnosis, and cancer stage. We included 1,816,461 patients with cancer, 6,459 (0.36%) of whom were HIV infected. Results Cancer-specific mortality was significantly elevated in HIV-infected compared with HIV-uninfected patients for many cancers: colorectum (adjusted hazard ratio [HR], 1.49; 95% CI, 1.21 to 1.84), pancreas (HR, 1.71; 95% CI, 1.35 to 2.18), larynx (HR, 1.62; 95% CI, 1.06 to 2.47), lung (HR, 1.28; 95% CI, 1.17 to 1.39), melanoma (HR, 1.72; 95% CI, 1.09 to 2.70), breast (HR, 2.61; 95% CI, 2.06 to 3.31), and prostate (HR, 1.57; 95% CI, 1.02 to 2.41). HIV was not associated with increased cancer-specific mortality for anal cancer, Hodgkin lymphoma, or diffuse large B-cell lymphoma. After further adjustment for cancer treatment, HIV remained associated with elevated cancer-specific mortality for common non–AIDS-defining cancers: colorectum (HR, 1.40; 95% CI, 1.09 to 1.80), lung (HR, 1.28; 95% CI, 1.14 to 1.44), melanoma (HR, 1.93; 95% CI, 1.14 to 3.27), and breast (HR, 2.64; 95% CI, 1.86 to 3.73). Conclusion HIV-infected patients with cancer experienced higher cancer-specific mortality than HIV-uninfected patients, independent of cancer stage or receipt of cancer treatment. The elevation in cancer-specific mortality among HIV-infected patients may be attributable to unmeasured stage or treatment differences as well as a direct relationship between immunosuppression and tumor progression.

HIV Infection and Survival of Lymphoma Patients in the Era of Highly Active Antiretroviral Therapy

“…We were not able to examine lymphoma-specific survival, which reflects prognosis of lymphoma more accurately and is less susceptible to comorbidities and other competing risks of death, due to lack of information. Interestingly, a recent study linking data from the HIV/AIDS registries and cancer registries in six U.S. states found that HIV infection was associated with elevated cancer-specific mortality for many cancers but not for lymphoma (42). These limitations highlight the importance of performing prospective studies in this underserved population to understand the factors that impact outcomes for patients with HIV and lymphoma and to learn how to best eliminate disparities in outcomes for them, particularly as management of HIV infection in the modern era continues to improve.…”

HIV-Associated Gastrointestinal Cancer

“…An autopsy study in AIDS patients showed diseases of the GIT in 79% [5]. The degree of immunosuppression has a profound negative influence on incidence and outcome of carcinoma, irrespective of whether the tumor is infection associated or not [4,6]. This was also shown in a large meta-analysis that compared more than 440,000 HIV-positive individuals with organ transplant patients [7].…”

“…In the study from the USA [4], compared to the normal population, adjusted cancer-specific mortality was significantly elevated for the following GI malignancies: pancreas (hazard ratio (HR) 1.71), colorectum (HR 1.49), and liver (HR 1.17). Markedly poor survival was demonstrated for liver cancer in another study [6].…”

“…This was shown especially for tumors of the breast, melanoma, pancreas, larynx, prostate, colorectum, and lung cancer (order according to strength of effect) [4]. The gastrointestinal tract (GIT) plays a significant role in this context.…”

Sarcomas other than Kaposi's sarcoma in HIV

“…HACM data reported that 32.3 % of people living with HIV with cancer present with distant disease versus 17.7 % in the general population, p<0.01. 18 The small number of cases in both groups is a shortcoming. The exclusion of adolescent patients (in whom osteosarcoma is most prevalent) further decreased the sample size which was too small, for example, to determine if there was an increased risk of metastases in any of the osteosarcoma subtypes.…”