Spectrum of Cancer Risk Late After AIDS Onset in the United States

Abstract

Context Persons living with AIDS today remain at elevated cancer risk. Highly active antiretroviral therapy (HAART), widely available since 1996, prolongs life, but immune function is not fully restored. Objectives To assess long-term cancer risk among persons with AIDS relative to the general population and the impact of HAART on cancer incidence. Design, Setting, and Subjects Records of 263,254 adults and adolescents with AIDS (1980-2004) from 15 U.S. regions were matched to cancer registries to capture incident cancers during years 3-5 and 6-10 after AIDS onset. Main Outcome Measure Standardized incidence ratios (SIRs) assessed risks relative to the general population. Rate ratios (RRs) compared cancer incidence before and after 1996 to assess the impact of availability of HAART. Results Risk was elevated for the two major AIDS-defining cancers, Kaposi sarcoma (SIRs 5321 and 1347 in the 3-5 and 6-10 year periods, respectively) and non-Hodgkin lymphoma (SIRs 32 and 15). Incidence of both malignancies declined in the HAART era (1996-2006). Risk was elevated for all non-AIDS defining cancers combined (SIRs 1.7 and 1.6 in years 3-5 and 6-10, respectively), and for the following specific non-AIDS-defining cancers: cancers of the oral cavity/pharynx, tongue, anus, liver, larynx, lung/bronchus, and penis, and Hodgkin lymphoma. Anal cancer incidence increased between 1990-1995 and 1996-2006 (RR 2.9, 95%CI 2.1-4.0), as did Hodgkin lymphoma (RR 2.0, 95%CI 1.3-2.9). Conclusion Among people who survived an AIDS diagnosis for several years or more, we observed high risks of AIDS-defining cancers and increasing incidence of anal cancer and Hodgkin lymphoma.

Epidemiologic Trends of Cancer Diagnoses Among HIV-infected Children in Spain From 1997 to 2008

“…1,2 Furthermore, the introduction of HAART has greatly influenced the incidence of cancer in people with HIV or acquired immunodeficiency disease syndrome (AIDS). [3][4][5][6] The decrease in the prevalence of severe immunodeficiency has resulted in a rapid reduction of AIDS-defining malignancies (ADM) such as Kaposi sarcoma, non-Hodgkin lymphoma (NHL), and invasive cervical carcinoma. However, improved survival has been accompanied by an increase in the likelihood of developing non-AIDS-defining malignancies (non-ADM) in HIVinfected adults.…”

Chronic Liver Disease in the Human Immunodeficiency Virus Patient

“…135 Previously, prevalence rates of up to 22% were reported in autopsy series. Herpesvirus 8 has classically been associated with Kaposi sarcoma.…”

The Need for Anal Dysplasia Screening and Treatment Programs for HIV-Infected Men Who Have Sex With Men

“…In the period before ART was available, the incidence of anal cancer among all HIV-infected persons was nearly 20 times that of the general population (Patel et al, 2008) and was even higher for HIV-infected MSM compared with other HIV-infected groups (D'Souza et al, 2008). It was hoped that the incidence of anal cancer would decrease when ART became widely available, but while the incidence for many other cancers did decrease, the rate for anal cancer actually increased (Simard, Pfeiffer, & Engels, 2010). Patel et al (2008) compared the incidence of anal cancer among HIV-infected persons to that of the general population in the United States during three time periods: the pre-ART period from 1992 through 1995, the early ART period from 1996 through 1999, and the later ART period from 2000 through 2003.…”