Incidence and risk factors for the occurrence of non‐AIDS‐defining cancers among human immunodeficiency virus‐infected individuals

Burgi, Alina; Brodine, Stephanie K.; Wegner, Scott A.; Milazzo, Mark; Wallace, Mark R.; Spooner, Katherine; Blazes, David L.; Agan, Brian K.; Armstrong, Adam W.; Fraser, Susan; Crum, Nancy F.

doi:10.1002/cncr.21334

Cited by 205 publications

(147 citation statements)

References 27 publications

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“…22,30 However, only a few of these studies focused on CD4 count as a measure of immunodeficiency. 18,28,29 It is important to distinguish between CD4 count nadir and current CD4 count; the former measures the lowest point the CD4 count has reached and will address the long-term risk of non-AIDS-defining malignancies.…”

Section: Discussionmentioning

confidence: 99%

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

Reekie

Kósa

Engsig

et al. 2010

Cancer

128

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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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Section: Discussionmentioning

confidence: 99%

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

Reekie

Kósa

Engsig

et al. 2010

Cancer

128

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“…24 Based on these and several other large retrospective population-based studies, it is difficult to determine if there is an increased or decreased incidence of HIV in an age-matched general population. 25,26 These observationbased, epidemiologic studies simply look at incidence of PCa in an HIV-positive cohort which is dependent on detection and, thus, PSA and DRE screening. It has been hypothesized that reports of lower incidence of PCa in HIV positive individuals may be due to decreased screening of this group.…”

Section: Prostate Cancermentioning

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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“…89 Overall, patients with HIV infection have a 1.5-to 2-fold increased risk of malignancy. [89][90][91] Melanoma is one of these cancers, 91,92 with a standardized rate ratio of 2.6 (95% CI, 1.9-3.6). 89 Multiple case studies also have reported malignant melanoma in HIV-infected patients, with melanoma at times exhibiting an aggressive course.…”

Section: Melanoma In Patients With Hiv Infection/aidsmentioning

confidence: 99%

“…94 Most studies point to HAART and its associated immune reconstitution as possible sources of improved prognosis in patients with HIV infection and melanoma. 94 The study by Burgi et al 91 showed that HAART had a protective effect against the development of non-AIDS-defining cancer. Yet, this same conclusion did not apply to melanoma because of the study's small number of melanoma patients.…”

Section: Melanoma In Patients With Hiv Infection/aidsmentioning

confidence: 99%

“…Of note, various studies did not find an association between the CD4 cell count, the onset of AIDS, and the risk of non-AIDS-defining cancers. 91,95 Thus, the relationship is still unclear among CD4 count, HAART, HIV RNA viral load, and melanoma incidence, as well as disease course. [94][95][96] HIV and Immune Modulation Although the mechanism of HIV's impact on melanoma is still unclear, some evidence suggests the role of immune modulation.…”

Section: Melanoma In Patients With Hiv Infection/aidsmentioning

confidence: 99%

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Melanoma in Immunosuppressed Patients

Kubica

Brewer

2012

Mayo Clinic Proceedings

105

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The immunogenic characteristics of malignant melanoma are intriguing. To date, multiple studies exist regarding the immunogenicity of melanoma. In this article, we summarize data in the literature on the role of immunosuppression in melanoma and discuss several immunocompromised patient populations in detail. A comprehensive PubMed search was conducted with no date limitation. The following search terms were used: melanoma in combination with immunosuppression, immunocompromised, genetics, antigen processing, UV radiation, organ transplantation, organ transplant recipients, lymphoproliferative disease, lymphoma, CLL, NHL, radiation, and HIV/AIDS. Although no formal criteria were used for inclusion of studies, most pertinent studies on the topic were reviewed, with the exception of smaller case reports and case series. The included studies were generally large (Ն1000 patients in organ transplant recipient studies; Ն500 patients in lymphoma studies), with a focus on institutional experiences, or population-based national or international epidemiologic studies. Melanoma-induced immunosuppression, the role of UV radiation in melanoma development, and the epidemiology, clinical course, and prognosis of melanoma in immunocompromised patients are highlighted. Organ transplant recipients, patients with lymphoproliferative disorders, patients with iatrogenic immunosuppression, and patients with human immunodeficiency virus infection/AIDS are also highlighted. Recommendations are proposed for the care and monitoring of immunosuppressed patients with melanoma. With better understanding of the molecular microenvironment and clinical course of melanoma in immunosuppressed patients, novel therapies could be developed and outcomes potentially affected in these patients.

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Incidence and risk factors for the occurrence of non‐AIDS‐defining cancers among human immunodeficiency virus‐infected individuals

Cited by 205 publications

References 27 publications

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

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

HIV and prostate cancer: a systematic review of the literature

Melanoma in Immunosuppressed Patients

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