Elevated risk for squamous cell carcinoma of the conjunctiva among adults with AIDS in the United States

Abstract

Squamous cell carcinoma of the conjunctiva (SCCC) has been associated with HIV infection in equatorial Africa, but the evidence for association with HIV in developed countries, where SCCC is rarer, is controversial. We investigated the risk for SCCC and other eye cancers in the updated U.S. HIV/AIDS Cancer Match Registry Study. We calculated standardized incidence ratios (SIRs) to estimate excess risk for SCCC, primary ocular lymphoma, ocular Kaposi sarcoma (KS) and other eye tumors among 491, 048 adults (aged > 15 years or older) with HIV/AIDS diagnosed from 1980 to 2004. We calculated relative proportions (per 10 5) to gain insight into risk factors. We identified 73 eye cancers (15 SCCC, 35 primary ocular lymphoma, 17 ocular KS and 6 other). Overall SIRs were elevated for SCCC (SIR, 12.2, 95% CI 6.8-20.2), primary ocular lymphoma (21.7, 95% CI 15.1-30.2) and ocular KS (109, 95% CI 63.5-175). Risk for SCCC was elevated regardless of HIV acquisition category, CD4 lymphocyte count and time relative to AIDS-onset. Relative proportions of SCCC risk were highest with age ≥50 (8/10 5), Hispanic ethnicity (7/10 5) and residence in regions with high-solar ultraviolet radiation (10/ 10 5). We show significantly increased incidence of SCCC among persons with HIV/AIDS in the U.S. The associations with age and geography are in accord with etiological role for ultraviolet radiation in SCCC.

Human papillomavirus infection and squamous cell carcinoma of the conjunctiva

“…The conjunctiva is the only site in equatorial Africans that is not protected from ultraviolet light by heavy pigmentation . A causal role of heavy ultraviolet light exposure in SCCC onset is strongly supported by the geographical distribution of the disease (IARC, 2007;Guech-Ongey et al, 2008), and by the preferential onset of the malignancy in the intra-palpebral zone that is the part of the conjunctiva most heavily exposed to ultraviolet light . It can probably be assumed that all Ugandans are heavily exposed to ultraviolet light and it is therefore not surprising that no clear association was observed between outdoor occupation and SCCC risk in our study.…”

“…The spread of human immunodeficiency virus (HIV) infection has been implicated in the rise of SCCC incidence both in Africa (Ateenyi-Agaba, 1995;Newton et al, 2001;Waddell et al, 2006) and the United States (Guech-Ongey et al, 2008), with an approximately 10-fold increased risk in individuals with HIV/AIDS. Mucosal human papillomavirus (HPV) types were initially suspected to have a role in SCCC onset because of their importance in the aetiology of carcinomas of the anogenital tract and oropharynx (IARC, 2007).…”

Infecção VIH e Neoplasias Não Definidoras de SIDA: Experiência de um Centro

“…No entanto é independente da forma de aquisição de VIH, valor de células CD4, ou tempo de evolução da infecção por VIH subjacente. 34 Neste caso, tratava--se de uma doente de raça negra, com infecção por VIH-2 conhecida com três anos de evolução, já muito imunodeprimida (CD4 99 células/ mm…”

Association of human papilloma virus with pterygia and ocular-surface squamous neoplasia

“…47 OSSN is often referred to as immune-associated (mediated by diminished immune surveillance), as the risk of developing this disease is increased by 12-fold in HIV-infected individuals 48 and by 20-fold in liver-transplant patients. 49 Conjunctival SCC represents the most severe form of OSSN, causing ocular morbidity and if left untreated can result in mortality.…”

“…This is relevant particularly in regions where HIV is endemic (eg, Sub-Saharan Africa), as it has been shown that HIV infection increases the risk of developing conjunctival tumors by greater than 10-fold. 48 38 Despite this, at least three independent studies observed HPV-16 in their pterygium specimens. 29,35,36 Concurrent disease: pterygia and OSSN Pterygia have been referred to as benign tumors due to their local invasiveness and propensity to recur but not to metastasize.…”