Survival among HIV-Infected and HIV-Uninfected Individuals with Common Non–AIDS-Defining Cancers

Abstract

Background Non-AIDS-defining cancers increasingly contribute to mortality among human immunodeficiency virus (HIV)-infected individuals. However, few studies have compared cancer prognosis by HIV status with adjustment for risk factors. Methods We conducted a cohort study of HIV-infected and HIV-uninfected adults in Kaiser Permanente California during 1996–2011, following subjects diagnosed with Hodgkin lymphoma (HL) or anal, prostate, colorectal, or lung cancers. We used Kaplan-Meier curves and Cox regression to assess cancer-related mortality within five years, comparing HIV-infected with HIV-uninfected subjects. Adjusted models included age, race/ethnicity, sex, cancer stage, cancer treatment, and smoking. Results Among HIV-infected and HIV-uninfected subjects, there were 68 and 51 cases of HL, 120 and 28 of anal cancer, 150 and 2050 of prostate cancer, 53 and 646 of colorectal cancer, and 80 and 507 of lung cancer, respectively. Five-year cancer-related survival was reduced for HIV-infected compared with HIV-uninfected subjects, reaching statistical significance for lung cancer (10% vs. 19%, P=0.002) but not HL (83% vs. 89%, P=0.40) or anal (64% vs. 74%, P=0.38), prostate (86% vs. 92%, P=0.074), or colorectal cancers (49% vs. 58%, P=0.55). Adjusted results were similar, with lung cancer (hazard ratio [HR] 1.3, 95% confidence interval [CI]: 1.0–1.7) and prostate cancer (HR 2.1, 95% CI: 1.1–4.1) reaching significance. Conclusions Cancer-related mortality was higher among HIV-infected compared with HIV-uninfected individuals for prostate and lung cancers, but not HL, anal cancer, or colorectal cancer. Impact Our findings emphasize the need for a focus on prevention, early detection, and adequate treatment of cancer among HIV-infected individuals.

HIV-Associated Lung Cancer

“…Even though pre-cART data suggested poorer prognosis for PLWHIV with LC [52,53,54,55], studies focusing in the post-cART era after 1996 found no significant differences in survival rates for PLWHIV [8,43,44,47,56]. The improved outcome is most likely related, in part, to the better overall health of PLWHIV, but also to the better care since having overcome several uncertainties and worries of the first years of the HIV epidemic.…”

HIV-Associated Gastrointestinal Cancer

“…Therapy of colorectal carcinoma is not different in HIV-positive compared to HIV-negative patients. After adjustment for age, race/ethnicity, sex, TNM stage, cancer treatment type, and smoking, cancer-related mortality was not statistically different with regards to colorectal cancer (HR 1.4, 95% confidence interval 0.8-2.7) in the Kaiser Permanente California cohort during 1996-2011 [34]. However, as stated earlier, in other cohorts adjusted cancer-specific mortality was significantly elevated for colorectum cancer (HR 1.49) [4,35], but with a rather small effect comparable to the HR shown in other cohorts.…”

“…In an Italian cohort, cancer of the liver Non-AIDS-defining cancer in general SIR 2.2-4 [8,9]; SIR in men increased [37], increasing [30,34,38] a All values significant. GI = gastrointestinal, aOR = adjusted odds ratio, HR = hazard ratio, PY = person years, SIR = standardized incidence ratio.…”

HIV-Associated Urogenital Malignancies

“…Results from the Kaiser Permanente cohort California showed a non-significant reduction in 5-year survival for HIV-infected subjects with prostate cancer compared to HIV-uninfected men (86% vs. 92%) [52]. Notably, after adjustment for age, race/ethnicity, sex, TNM stage, cancer treatment type, and smoking, cancerrelated mortality was higher among HIV-infected compared with HIV-negative subjects (hazard ratio (HR) 2.1).…”