Association of Cancer With AIDS-Related Immunosuppression in Adults

Frisch, Mørten; Biggar, Robert J.; Engels, Eric A.; Goedert, James J.

doi:10.1001/jama.285.13.1736

Cited by 744 publications

(526 citation statements)

References 40 publications

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“…Whereas MCCHL and LDCHL were strongly associated with HIV infection, all NSCHL, the most commonly diagnosed HL type in Rwanda, were HIV negative. This is consistent with studies in high‐income settings,21, 22, 23 but is the first formal report from sub‐Saharan Africa.…”

Section: Discussionsupporting

confidence: 91%

A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

Mpunga

Znaor

Uwizeye³

et al. 2018

Intl Journal of Cancer

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The aim of this study was to assess the association between HIV infection and cancer risk in Rwanda approximately a decade after the introduction of antiretroviral therapy (cART). All persons seeking cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda from 2012 to 2016 were routinely screened for HIV, prior to being confirmed with or without cancer (cases and controls, respectively). Cases were coded according to ICD‐O‐3 and converted to ICD10. Associations between individual cancer types and HIV were estimated using adjusted unconditional logistic regression. 2,656 cases and 1,196 controls differed by gender (80.3% vs. 70.8% female), age (mean 45.5 vs. 37.7 years), place of residence and proportion of diagnoses made by histopathology (87.5% vs. 67.4%). After adjustment for these variables, HIV was significantly associated with Kaposi Sarcoma (n = 60; OR = 110.3, 95%CI 46.8–259.6), non‐Hodgkin lymphoma (NHL) (n = 265; OR = 2.5, 1.4–4.6), Hodgkin lymphoma (HL) (n = 76; OR = 5.2, 2.3–11.6) and cancers of the cervix (n = 560; OR = 5.9, 3.8–9.2), vulva (n = 23; OR = 17.8, 6.3–50.1), penis (n = 29; OR = 8.3, 2.5–27.4) and eye (n = 17; OR = 4.7, 1.0–25.0). Associations varied by NHL/HL subtype, with that for NHL being limited to DLBCL (n = 56; OR = 6.6, 3.1–14.1), particularly plasmablastic lymphoma (n = 6, OR = 106, 12.1–921). No significant associations were seen with other commonly diagnosed cancers, including female breast cancer (n = 559), head and neck (n = 116) and colorectal cancer (n = 106). In conclusion, in the era of cART in Rwanda, HIV is associated with increased risk of a range of infection‐related cancers, and accounts for an important fraction of cancers presenting to a referral hospital.

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Section: Discussionsupporting

confidence: 91%

A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

Mpunga

Znaor

Uwizeye³

et al. 2018

Intl Journal of Cancer

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“…15 In addition, studies have found that vulva, vagina, penile, oral cavity, and pharynx cancers are caused by HPV, with limited association with cancer of the larynx. 11,21,25,35 Interestingly, previous studies have found a link between virus-related cancers such as HL, 27 HCC, 28 and anal cancer 26 with immunodeficiency determined by time to AIDS diagnosis 26,27 or CD4 count within 1 year of diagnosis. 28 The most common non-virus-related epithelial cancers (eg, lung and prostate) remain difficult to treat, and the majority remain incurable, with very little improvement in survival over the past decade 36 ; in addition, based on oncoepidemiologic studies, risk of epithelial cancers starts to increase at about the age of 30 years and increases progressively by age.…”

Section: Discussionmentioning

confidence: 99%

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

Reekie

Kósa

Engsig

et al. 2010

Cancer

129

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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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“…23 A similar linkage-based population study examining more than 300 000 people throughout the United States aged 15-69 years demonstrated a lower than expected incidence of PCa both in the overall (RR 0.7; 95% CI 0.6-0.9) and post-AIDS onset period (RR 0.5; 95% CI 0.4-0.7). 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.…”

Section: Prostate Cancermentioning

confidence: 99%

“…42 HAART may prove to be protective against the development of PCa and this may in part explain the reduced incidence of PCa seen in several of the large epidemiological studies outlined earlier. [23][24][25] It is interesting to note that several of the recently published studies of HIV-positive men with PCa did occur while these patients were receiving HAART. Pantanowitz et al noted that 82% of the men with HIV and PCa were receiving HAART, and Ng et al noted that 79% were receiving HAART.…”

Section: Highly Active Antiretroviral Therapymentioning

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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Association of Cancer With AIDS-Related Immunosuppression in Adults

Cited by 744 publications

References 40 publications

A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

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

HIV and prostate cancer: a systematic review of the literature

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